Cal Poly Pomona

Submit a Referral

Academic Senate Referral Request Form

  • Fill out the Referral Form online.
  • Provide all information requested in the form (incomplete referrals will be returned).
  • Print a copy of the completed form for your records.
  • Submit the form electronically by clicking on the "Submit by Email" button.

Academic Senate Referral Request Form (PDF)

Academic Senate Referral Request Form (Word)
If you prefer you may print the Referral Form and submit it in person or by campus mail:
Academic Senate Offices
Bldg. 98-P2-8

Referrals will be placed on the agenda of the next meeting of the Executive Committee if submitted no less than 5 work days (a week) before the date of the meeting. Under special circumstances and whenever possible, requests to waive the deadline may be granted with an appropriate justification.

Referral Process Flowchart

Referral Process flowchart


Download PDF of Referral Process Flowchart