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This petition may be used to request several actions by the University. A separate petition is required for each request and covers
only the specific request you are making.
ADDRESS: ___________________________________________________________________________________________________
____________________________________________________ Tel. _______________________________________
State specific request, outlining completely pertinent facts and details to support your request.
Attach additional sheet if necessary.
REQUEST FOR:
______________________________________________________________________
Reasons (s):
_______________________________________________________________________________
SIGNATURE _______________ DATE ___/___/___