First Name:*
 

Last Name:*
 

Student ID Number:*
  
  (Do not use ssn)

Division

----- LD1 LD2 LD3 LE1 LE2 LE3 LE4

Address:*
 

State:*

-- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

City:*
 

Zip:*

SHU Email:*
 

EXAMINATIONS
** List all of your in-class examinations in date order. 

  Date**

Time

Course Number
(Ex: PUBG7801MM)

Course Name
(Ex:Administrative Law)

Professor

Reason for Rescheduling

According to the Conflicts Policy, one of the following criteria must exist in order to request an examination be rescheduled:

The date of a rescheduled examination will be as close to the originally scheduled date as possible.  For examinaitons rescheduled under either Rule 1, 2 or 3, ordinarily the second examination will be rescheduled to a later date.