Petition to Change Studio Instructor/ Split Studio Lessons

Student Information

Longy Student ID

First Name

Last Name

Longy Email Address

Program Information

Degree

Program

Major/Concentration:

Department Chair Information

Name of Department Chair

Department Chair Longy Email

Requested Action:

Please indicate what action you would like taken:

Current Studio Instructor Information

Name of Current Studio Instructor

Current Studio Instructor Longy Email

Split Studio Instructor

In the fields below, please list the the instructor and credit information for your split studio request:

Instructor A Information:

Instructor A:

Instructor A email:

Credits with Instructor A:

Instructor B Information:

Instructor B:

Instructor B email:

Credits with Instructor B:

New Studio Instructor Information

Name of New Studio Instructor

New Studio Instructor Longy Email

Student Signature and Acknowledgement

Electronic Signatures: I acknowledge and agree this form may be executed by electronic signature, which shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.

Yes

The Petition to Change Studio Instructor form requires to student to follow the steps below:

1. Student must meet with their department chair to discuss a change in studio instructor.
2. Student must meet with their current studio instructor to discuss change in studio instructor.
3. Student must meet with Dean Bose and receive approval to pursue a change in studio instructor.
4. After steps 1-3 have been completed, the student must set up a trial lesson with another studio instructor. If that instructor agrees to teach, the instructor will sign off on this form when notified.

I am petitioning to change my studio instructor and agree to follow the procedure outlined above.

Agree

Disagree

The Petition to Split Studio Instructor form requires to student to follow the steps below:

1. Student must meet with their department chair to discuss splitting studio instruction between the current instructor and an additional one.
.
2. Student must meet with their current instructor to discuss this change in the number of lessons that will take place.
3. Student must meet with Associate Dean Teeters and receive approval to pursue approval to split studio instruction.
4. After steps 1-3 have been completed, the student must set up a trial lesson with another studio instructor. If that instructor agrees to teach, the instructor will sign off on this form when notified.

I am petitioning to split my studio instruction and agree to follow the procedure outlined above.

Agree

Disagree

Student Signature

Date