Petition for Policy Variance

"*" indicates required fields

Student Name

MTECH ID*

Address*

Street Address Address Line 2 City State ZIP Code

Date of Petition*

Program*

Campus

Teacher/Advisor*

Variance Details*

Please provide all details and attach any documentation to be considered for determining variance. Some questions to consider: 1) What are you requesting and why? 2) What will change if this variance is approved?

Additional Documentation

Drop files here or

Max. file size: 50 MB.

Signature*

This form is to be used to determine variances of college policies and procedures. A petition must be filed within thirty (30) days of the occurrence of the circumstance upon which it is based. All determinations are based on the submitted documentation. Any disputes regarding the determination will be addressed according to the MTECH Grievance policies and procedures.

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