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School of Graduate Studies andResearch515 Orr DriveRoom 469 Tucker HallTallahassee, FL 32307

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Application for Graduate Funding

graduatestudies/Application for Graduate Funding_2_2_17.pdf

REGISTRATION

Approval for Graduate Student to take an Undergraduate Course

RESIDENCY

Florida ResidencyResidency Re-Classification for Tuition Purposes

FAMU FEEDER SCHOLARS PROGRAM

Graduate Feeder Application Fee Wavier

FUNDING

Certification of Financial ResponsibilityResidency AffidavitSUS Special Summer Program

Health Insurance Eligibility Form

Health Insurance for International StudentsHealth Insurance Verification for International Students

THESES AND DISSERTATIONS

Defense Announcement TemplateDefense Outcome FormFAMU Final Term Degree Clearance Checklist FormFAMU ETD Policy Compliance FormFAMU Policy ComplianceFAMU Proquest ETD ProcessInstitutional Review Board (IRB), IACUC and IBC FormsProquest LinkThesis and Dissertation Committee Approval FormThesis/Dissertation Binding ContractThesis and Dissertation Research Project Approval Form

GRIEVANCE**All grievances will be handled in an expeditious manner.

Grievance Procedure Form (for appeals other than grades)Stepwise Student Grievance Settlement Form (for grade appeals)

Progress Report Part One

graduatestudies/Progress Report_Part I_Research Supervisor and Student_6.2016.pdf

SCHOOL OF GRADUATE STUDIES AND RESEARCH

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Progress Report Part Two

graduatestudies/Progress Report_Part II_Student.pdf

GRADUATE STUDENT APPEALS

Petition for an Extension of Time to DegreeGraduate Academic Regulation Appeal Petition (for appealing academic suspensions,requesting a retroactive withdrawal, late add/swap, or an administrative drop)

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Florida Agricultural and Mechanical University Graduate Academic Regulation Appeal Petition

Please read thoroughly before submitting

The Graduate Council considers petitions from graduate students seeking exceptions to the academic regulations stated in the FAMU catalog. Appeal applications must be filed and considered prior to graduation. The attached form should be used for the following types of appeal: 1. Waiver of Academic Suspension 2. Late or retroactive course withdrawal (limited to one year after course enrollment) 3. Late add/swap of registration (limited to the next semester) 4. Administrative drop(s) – Department error 5. Late application for graduation (limited to four weeks after the published term deadline) 6. A total withdrawal for the semester cannot be processed using this form. Please contact your Dean’s Office for the proper procedure for obtaining the Petition for a Retroactive Term Withdrawal form.

NOTES: All supporting documentation must accompany all appeal petitions. This action could affect your current and future financial aid award(s); therefore, it is suggested that you check with the Office of Student Financial Aid for your status before submitting this petition.

Please adhere to the following: I. PETITIONS may be obtained from and returned to the Graduate Coordinator in the College/School of your major. The original completed Petition and supporting documents must be submitted. Colleges are not responsible for petitions that are not submitted directly to and discussed with the proper college representative. II. Deadline: The Graduate Council normally meets monthly. In order for a petition to be reviewed by the college/school and to be heard at a regular meeting, it must be submitted by the end of the first week of each month. Petitions for re-admission (after an academic suspension) must be submitted at least ten working days before the start of classes.

III. SUPPORTING DOCUMENTATION REQUIRED: A. If the problem is health related, a written statement from an attending physician, Student Health Services and/or Counseling Center must accompany this petition. The statement must be on the original attached medical form or on letterhead stationery, specifying the dates and the nature of your illness, and indicating that your illness was of such severity as to affect college work and class attendance. B. If you are citing other circumstances, beyond your control, as the reason for your difficulty, then the petition letterhead stationary is required. C. If you have had personal problems, which have affected your college work, and you desire confidentiality, then you should consult with the Counseling Center, on-campus, and request a written letter of support, which should be submitted in a sealed envelope.

IV. ACADEMIC SUSPENSION WAIVER:

If you are petitioning for a reinstatement because of an Academic Suspension, please be advised that, if approved, you will be placed on academic probation. You will be required to obtain a minimum term GPA of 3.0 the next semester. Failure to do so will result in you being placed on a final academic suspension.

Florida Agricultural and Mechanical University Graduate Academic Regulation Appeal Petition

V. NOTIFICATION: The Graduate Studies’ Office will notify you of the Graduate Council’s decision, in writing, at the address you provided on the petition form. You will be contacted by your college/school’s representative within 48 hours of the meeting. Please note that if you pre-registered, your classes will not automatically be reinstated; therefore, you must contact your academic advisor so that you may re-register for classes. VI. CONTACT: Please contact your College/School Representative listed below should you have any questions.

ACADEMIC REGULATION APPEALS GRADUATE REPRESENTATIVES

Graduate Council Chair, Dr. David H. Jackson, Jr., david.jackson@famu.edu Agriculture and Food Sciences, Dr. James Muchovej, james.muchovej@famu.edu

Allied Health Sciences, Dr. Dawn Brown-Cross, dawn.browncross@famu.edu Architecture, Prof. Valerie Goodwin Architecture, Valerie.goodwin@famu.edu Business and Industry, Ms. Felicia Williams SBI, Felicia.williams@famu.edu

Education, Dr. Patricia Green-Powell, patricia.green-powell@famu.edu Engineering, Dr. Reginald Perry, reginald.perry@famu.edu

Environment, Dr. Frederic Essien, Frederic.essien@famu.edu Journalism, Dr. Valerie White, Valerie.white@famu.edu

Nursing, Dr. Jaibun Earp, jaibun.earp@famu.edu Pharmacy and Pharmaceutical Sciences, Dr. Carl Goodman, carl.goodman@famu.edu

Science and Technology, Dr. Lekan Latinwo, lekan.latinwo@famu.edu Social Sciences, Arts & Humanities, Dr. Kyle Eidahl, kyle.eidahl@famu.edu

MF: Revised 6/5/17

COLLEGE /SCHOOL REPRESENTATIVE BLDG./ROOM PHONE Graduate Council Chair Dr. David H. Jackson, Jr. Tucker Hall / RM 469 850-599-3505 Agriculture and Food

Sciences Dr. James Muchovej George Connolly

Greenhouse 850-561-2582

Allied Health Sciences Dr. Dawn Brown- Cross Lewis Beck /RM 309 850-561-2014 Architecture Prof. Valerie Goodwin Architecture/RM 232H 850-599-3244

Business and Industry Ms. Felicia Williams SBI /RM 302E 850-561-2371 Education Dr. Patricia Green-Powell Brooksville Campus 850-599-3483

Engineering Dr. Reginald Perry COEA/RM 001 850-410-6465 Environment Dr. Marcia Allen Owens FSHS/RM 308L 850-599-8556

Nursing Dr. Jaiburn Earp WARE RHANEY / RM 108 850-561-2969 Pharmacy &

Pharmaceutical Sciences Dr. Carl Goodman Dyson Pharmacy / RM

201 850-599-3867

Science and Technology Dr. LeKan Latinwo JONES/ RM 101C 850-599-3907 Social Sciences, Arts &

Humanities Dr. Kyle Eidahl Tucker Hall / RM 403 850-599-3390

Florida Agricultural and Mechanical University Graduate Academic Regulation Appeal Petition

(MUST BE LEGIBLE – USE BALL POINT PEN OR TYPE)

NAME: __________________________________ STUDENT I.D. #: _____________________________ ADDRESS: ________________________________ CITY/STATE/ZIP: ____________________________ PHONE #: ________________________________ E-MAIL: __________________________________ CHECK NATURE OF PETITION: A. WAIVER OF ACADEMIC SUSPENSION: ( ) Fall ( ) Spring ( ) Summer Year __________ B. RETROACTIVE COURSE WITHDRAWAL: ( ) Fall ( ) Spring ( ) Summer Year __________ Must Include Below:

*Prefix _______ Course # _______ Class # ______ Section ______ Hours___ Date last attended ______ *Prefix _______ Course # _______ Class # ______ Section ______ Hours___ Date last attended ______ *Prefix _______ Course # _______ Class # ______ Section ______ Hours___ Date last attended ______ *Prefix _______ Course # _______ Class # ______ Section ______ Hours___ Date last attended ______ C. LATE COURSE ADD: ( ) Fall ( ) Spring ( ) Summer Year __________ *Prefix _______ Course # ________ Class # _______ Section _______ Hours _____ (Add ) *Prefix _______ Course # ________ Class # _______ Section _______ Hours _____ (Add ) *Prefix _______ Course # ________ Class # _______ Section _______ Hours _____ (Add ) *Prefix _______ Course # ________ Class # _______ Section _______ Hours _____ (Add) D. SWAP a COURSE: ( ) Fall ( ) Spring ( ) Summer Year __________ Drop (Swap) *Prefix_______ Course # ________ Class #________ Section ________ Hours _______ ↓

→Add (Swap)*Prefix ______ Course # ________ Class #________ Section ________ Hours _______ E. CHANGE HOURS: ( ) Fall ( ) Spring ( ) Summer Year __________ Use this section to change (increase/decrease) the hours for a course in which you are currently enrolled: *Prefix________ Course #_________ Class #________ Section _______ Change Hours (from)______hrs (to)_______hrs F. ADMINISTRATIVE DROP: ( ) Fall ( ) Spring ( ) Summer Year __________ (An Administrative Drop request requires the Dean’s or Director’s signature.)

*Prefix __________ Course # ____________ Class # _________ Section ___________ Hours ______ *Prefix __________ Course # ____________ Class # _________ Section ___________ Hours______ *Prefix __________ Course # ____________ Class # _________ Section ___________ Hours______ G. LATE APPLICATION FOR GRADUATION FOR TERM: ___________________ Year ____________ H. OTHER: Specify ___________________________________________________________________ I. What term did you begin your current graduate program? (Sem) ___________ (Year) _________ J. Are you currently enrolled? Yes ( ) No ( ); If “No”, indicate last term enrolled _________; K. Current Semester Hours _______; Present Major ______________________; If you are changing your major, then please attach an approved Change of Major form. L. ON A SEPARATE SHEET OF PAPER, PLEASE EXPLAIN IN DETAIL THE FOLLOWING:

The specific nature of your problem;

The reason why the University’s General Regulations should be set aside for you (including why you did not withdraw by the regular withdrawal deadline). In addition, please attach additional pages and/or documentation you deem necessary and a copy of your current unofficial transcript. The academic regulations that apply to all students are available in the FAMU catalog.

Student Signature: _____________________________________ Date: ______________________

GRADUATE ACADEMIC REGULATION APPEAL PETITION GRADUATE COUNCIL’ DECISION FORM

Graduate Council Representative (Chair): __________________________________________ Print Name

( ) Recommend Approval ( ) Recommend Disapproval ( ) Defer To Graduate Council

Comments: ________________________________ ________________________ Graduate Council Representative Signature Date

_____________________________________________________________________________________________________

THE DECISION OF THE GRADUATE COUNCIL IS AS FOLLOWS:

( ) Approved ( ) Disapproved ( ) No Action ( ) Approved pending receipt of: Comments:

________________________________________ _________________________ Academic Appeal Chairperson Signature Date

Associate Provost for Graduate Education and

Dean of the Graduate College

MF: Revised 6/5/17

Florida Agricultural and Mechanical University Graduate Academic Regulation Appeal Petition

GRADUATE COUNCILS’ INSTRUCTOR’S STATEMENT The student listed below is petitioning the Graduate Council for a Retroactive withdrawal/ Late Add/Swap, from your course. Please answer all of the following questions concerning the student and return this form to the Graduate Coordinator in the College/School.

Instructor: _____________________________________ Student: ______________________________ Course: _______________________________________ Student I.D. ____________________________ Semester: Fall ___________ Spring ____________ Summer ____________ Year ____________ (*Please answer question #1, if the appeal is for a late add request only) 1. * Does the student have permission to add this class late? ( ) Yes ( ) No 2. What was the student’s attendance record? ( ) Never Attended ( ) Irregular Attendance ( ) Completed Semester 3. If attended, what date did the student stop attending class? _________________________ (Information required pursuant to federal regulations for financial aid assistance.)

4. How was the student performing at the time he/she stopped attending class? ( ) Passing ( ) Failing ( ) No Information Available Comments: 5. How was the student performing at the withdrawal deadline? ( ) Passing ( ) Failing ( ) No Information Available Comments: 8. Did the student have any basis for estimating his/her performance level prior to the withdrawal deadline and/or the impact on the final grade? (Graded exams, papers, assignments, etc.) ( ) Yes ( ) No Comments: 9. What is your reaction to this student being permitted to withdraw from your course late? ( ) Support ( ) No Objection ( ) Oppose 10. Based on his/her academic performance, attitude toward meeting the requirements of the class, and any other factors you deem pertinent, state your honest opinion on whether the academic regulation governing course withdrawal should be set aside for this student. _____________________________________________________________________________________ _____________________________________________________________________________________ ________________________________ ________________________ _______________________________ Instructor’s Name (Please print) Signature Campus Number/Email _________________________ Date

MF: Revised 6/5/17

Florida Agricultural and Mechanical University Graduate Academic Regulation Appeal Medical Form

(MUST BE LEGIBLE – USE BALL POINT PEN OR TYPE)

DIRECTIONS: The lower part of this form should be completed by the appropriate medical professional and the entire form should be returned, in a sealed envelope from the physician’s office, with the name, address and phone number inscribed to your Appeal Representative along with your petition.

TO BE FILLED IN BY THE STUDENT: 1. Student: __________________________________ Student ID#:___________________________ 2. Medical Problem Pertains to: (Check One) ( ) Student ( ) Immediate Family Member 3. Relevant Time Frame: From: __________________________ To: _____________________________ (Include Total Dates) 4. This will authorize Dr. ____________________ to release the information requested below to the Florida A&M University Academic Regulation Appeals Graduate Council’ for the purpose of supporting my appeals petition. _________________________ ___________ __________________________ ________ Witness Signature Date Student Signature Date ____________________________________________________________________________ TO BE FILLED IN BY PHYSICIAN: The student listed above is petitioning the Graduate Council of the Florida A&M University for special consideration regarding a FAMU regulation. The student feels that a medical problem may have directly or indirectly contributed to the need for such consideration. We would appreciate your cooperation in answering the following questions. Please provide all pertinent data so that an appropriate decision can be made. Thank you for your help in this matter. 1. Physician’s Name: _________________________________________ Email:_________________________ 2. Address: ________________________________________________________________________________ 3. Telephone #: (_____) ________________________4. License# & State: _____________________________ 5. Dates you treated this student _____________________________ or family member: _________________ 6. If family member, please indicate relationship to the student: _____________________________________ Please answer the following questions, based upon the severity of your patient’s illness that could have affected his/her college work.

7. In your opinion, was the student able to attend class after treatment? ( ) Yes ( ) No If not, how long was the student required to be away from school? ____________________________________ 8. Could the length of class affect the student’s ability to attend (e.g. student could attend at least 1 hour but not Be physically active)? ( ) Yes ( ) No Please explain: 9. Could a strenuous class be a factor in the student’s inability to attend (e.g. could the student sit for an hour but not be physically active)? ( ) Yes ( ) No Please explain:

10. Could the medical condition affect the student’s ability to study or participate in class for extended periods of time? ( ) Yes ( ) No Please explain:

11. Could the medications you prescribed have interfered in any way with student’s academic performance? ( ) Yes ( ) No Please explain:

Additional Comments: Physician’s Signature_____________________________________ Date: _______________________