RR - Graduate School
Revised 4/27/17
Request for Special Action Form
Last Name _____________________ First Name __________________________ VID _______________________
Program ___________________________________________________________________ Degree ___________________________
Student’s VCU Email Address __________________________________________________________________________________
□ Change provisional admit status granted for academic reasons [AP] to full admit [AF]: sem/yr _____________________________
[SATISFACTION OF ACADEMIC PROVISIONS MUST BE MET NO LATER THAN THE END OF TWELVE MONTHS AFTER MATRICULATION TERM.]
□ Change/Drop concentration from ______________________________________ to ________________________________________
Effective sem/yr ___________________________________________________________________________________________
□ Add second concentration____________________________________ effective sem/yr
□ Change degree from _______________ to ___________________ WITHIN SAME MAJOR
□ Add second degree ________________ effective ________ sem/yr □ primary billing □ secondary billing
□ Student WILL complete and graduate from current program at end of sem/yr ________________________________________
and will begin new matriculation at beginning of sem/yr _________________________________________________________
□ Student WILL NOT complete/graduate from current program but will begin new matriculation on date indicated above.
□ Admit to graduate program that is restricted to direct student application online
Program________________________________________________________________________________________________
Effective sem/yr_________________________________________________________________________________________
□ Request approval for enrollment in a second degree/dual enrollment
New degree____________________________________________________________________________________________
Effective sem/yr_________________________________________________________________________________________
[APPROVAL FROM BOTH GPD AND GRADUATE SCHOOL REQUIRED.]
□ Leave of Absence: from beginning of sem/yr _________________________ through end of sem/yr __________________________
□ Medical LOA, attach medical documentation. □ Military LOA, attach copy of military orders or relevant documentation.
[LOA temporarily suspends continuous enrollment requirement but does not extend
time limit for completion of degree – 6 years for Certificates & Masters, 8 years ph.d.]
Leaves of absence can affect Federal Direct Subsidized Loans and Direct Unsubsidized Loans repayments grace periods. Per the U.S. Department of Education, students have a six-month grace period before being required to begin repayment. Leaves greater than six months may initiate loan repayment.
□ Early return from Leave of Absence: effective beginning of sem/yr _________________________________________________ [graduate school must re-open matriculation before student can register.]
□ Extension of time limit for degree: from beginning of sem/yr ___________________ through end of sem/yr __________________
□ Confirm all courses taken will still be relevant & current to discipline/curriculum by time student completes program. [ATTACH SUPPORTING DOCUMENTATION]
□ CHECK BOX IF THIS IS TO BE FINAL EXTENSION & LIST ALL PREVIOUS APPROVED EXTENSIONS
Catalog Term: _________________ Overall time to degree if extension approved.______________
from beginning of sem/yr ___________________ through end of sem/yr __________________
from beginning of sem/yr ___________________ through end of sem/yr __________________
□ Transfer of course work from other institutions, including course work taken under auspices of study abroad program at VCU
|Institution |
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Blair House
408 West Franklin Street
Box 843051
Richmond, VA 23284-3051
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