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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