University of California, Berkeley
RETROACTIVE CHANGE IN CLASS SCHEDULE PETITION
Instructions: 1. Complete the STUDENT SECTION below. 2. Complete the GRADUATE PETITION TO CHANGE CLASS SCHEDULE, http://registrar.berkeley.edu/GeneralInfo/elecforms.html. 3. Take both forms to the course instructor. The instructor must complete and sign the INSTRUCTOR SECTION below and sign the appropriate sections of the GRADUATE PETITION TO CHANGE CLASS SCHEDULE. The instructor must return both to the Graduate Assistant. 4. Graduate Assistant will forward this request to the Head Graduate Advisor. If approved by the HGA, all forms will be sent to the Graduate Division for a final decision.
STUDENT SECTION: Course Information and Reason for Retroactive Change Student: Course #: Reason for Retroactive Change: CCN: SID #: Semester:
Date: Student Signature INSTRUCTOR SECTION: Support, Certification of Attendance and Grade (if applicable) Please indicate if you support the student’s petition. If yes, certify attendance, participation and any other relevant information. If not, please explain.
If applicable, assign grade:
(letter grade or S/U)
Instructor (please print)