# Petition Request Form

**Source**: https://warwick.ac.uk/services/gov/petitions/petitions-form/
**Parent**: https://warwick.ac.uk/services/gov/policies/academicmanual/policy-directory/

\

{"elements":[{"isDiscrete":false,"hidden":false,"name":"1450105252694\_0.4366769996023945\_0.45235712386083404","readOnly":false,"id":196711017,"type":"commentElement"},{"isDiscrete":false,"hidden":false,"name":"Title of Petition","readOnly":false,"id":196733052,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Name of Lead Petitioner","readOnly":false,"id":196742370,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Name of Society or Campaign Group (if applicable)","readOnly":false,"id":196711020,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Contact Email Address","readOnly":false,"id":196731867,"type":"emailElement"},{"isDiscrete":false,"hidden":false,"name":"Please provide a brief outline of the substance of the petition (max.250 words)","readOnly":false,"id":196733407,"type":"textBoxElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"false","value":"0-false"},{"text":"false","value":"1-false"},{},{"text":"false","value":"3-false"},{"text":"false","value":"4-false"}],"name":"Please upload your petition here","readOnly":false,"id":196734669,"type":"attachment"},{"isDiscrete":true,"hidden":false,"values":[{"text":"No","value":"0-no"},{"text":"Yes","value":"1-yes"}],"name":"Please indicate whether you have raised the issue in any other University forum","readOnly":false,"id":196733847,"type":"radioElement"},{"isDiscrete":false,"hidden":false,"name":"If you have answered yes to the above please give details","readOnly":false,"id":196734282,"type":"textBoxElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"In Person, in addtion to this on-line submission (we will contact you to make an appointment with the University Secretary via the email address you provided above)","value":"0-inpersoninaddtiontothisonlinesubmissionwewillcontactyoutomakeanappointmentwiththeuniversitysecretaryviatheemailaddressyouprovidedabove"},{"text":"By Post","value":"1-bypost"}],"name":"Please indicate here whether in addtion to uploading your petition you also wish to submit your petition in person or by post (please note that you can only select one option)","readOnly":false,"id":196732634,"type":"radioElement"},{"isDiscrete":false,"hidden":false,"name":"1755107455221\_0.6606719451868878\_0.12852474279702641","readOnly":false,"id":196738139,"type":"commentElement"}]}

Please ensure that you have read the Protocol for the Delivery and Receipt of Petitions and Submissions before completing this form.
\
 

---

Title of Petition

Name of Lead Petitioner

Name of Society, Union or Campaign Group (if applicable)

Contact Email Address

Please provide a brief outline of the substance of the petition (max.250 words)

Please upload your petition here

Attach file 

No files are currently attached.

No

Yes

If you have answered yes to the above please give details

In Person, in addtion to this on-line submission (we will contact you to make an appointment with the University Secretary via the email address you provided above)

By Post

If you wish to submit your petition by post, please address it to: Chris Twine, University Secretary, University House, University of Warwick Coventry CV4 8UW

**Privacy notice**

This form will be used to inform the University of your intention to submit a petition in person to the University, or to provide you with a means of submitting a petition online. Your personal details will not be used for any purpose other than to contact you with specific reference to your petition or request for an appointment to submit your petition in person.

The University of Warwick is the Data Controller of any information you have entered on this form and is
committed to protecting the rights of individuals in line with Data Protection Legislation. The
University's
[Data Protection webpages](https://warwick.ac.uk/privacy)
provide further information on your rights and how the University
processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a
suspected personal data breach, please contact the University’s Data Protection Officer by email at
[infocompliance@warwick.ac.uk](mailto:infocompliance@warwick.ac.uk).

Spam prevention

## Failure to load reCAPTCHA

reCAPTCHA is a utility used to verify you're not a robot filling out this form. Unfortunately this has failed to load correctly.

Please try reloading the page. If the problem persists, or if you are in a country which blocks Google products, please contact us by using the 'page contact' link at the foot of this page.

Reload page