Name__________________________________________________Student ID:______________ Date_________
Degree Program________________________________________Year in Program_______________________
I hereby request permission to: ________________________________________________________________
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The reasons are: ____________________________________________________________________________
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Date submitted:______________________________ Signature:______________________________________
Approval Signatures: Yes No Comments:
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Advisor
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Instructor
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Instructor
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Action by Chair of Advisor’s Division Approved____________ Denied___________
_________________________________________________________Initials________Date_______________
Action by Director of M.A. Program Approved____________ Denied___________
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Action by Dean Approved____________ Denied___________
_________________________________________________________Initials________Date_______________
Comment by Registrar_______________________________________________________________________
Copies to_______________________________________________By___________on(Date)______________
Lutheran School of Theology at Chicago 1100
E. 55th Street Chicago, IL 60615 (773) 256-0700