ADA Petition to Request a Change in Degree Requirement

(For best results, please fill out this form using the Google Chrome Browser.)

This form will be submitted to the ADA Coordinator/Dean of Student Affairs and will be required to receive approval from the student's Advisor, School Dean, Registrar and Academic Vice President. Student Services personnel will obtain these signatures.

If you have any questions please contact the Dean of Student Affairs at (580) 327-8415 or at cnmosburg@nwosu.edu.

Student Information

First and Last Name *

Email Address (to receive a copy of this form) *

Street Address *

City *

State *

Zip Code *

Class Name and Number *

Reason for Requested Change *

Class Substitution *

A copy of this completed form will be furnished to the Student, Student's Advisor, School Dean, and Registrar. Once the form is submitted and reviewed, the ADA Coordinator/Dean of Student Affairs will correspond with the student to let them know of a decision.