ACADEMIC PETITION
SUBMIT COMPLETED FORM TO ADMISSION/RECORDS
I. Student Information
Name
Stinger ID
First Last
Address
Street City State Zip Phone
Program Major
(You must provide COMPLETE name of major. EXAMPLE: Business Management – Marketing Option)
Expected Date of Graduation
Check One: AA AS AAS AFA DIPL CERT
II. Explain your petition and reason for request below; attach additional sheets as needed and supply your
DARS audit to show why this petition is necessary:
III. Student Signature_______________________________________________Date_______________________
IV. RCTC Program Leader/Division Coordinator Recommendation
SUPPORT (check one): ____Yes ____No
Detailed Recommendation Rationale (attach additional sheets as needed):
RCTC Signature____________________________ Print Name_________________________Date_____________
IT IS MANDATORY FOR THE STUDENT TO OBTAIN A RECOMMENDATION WITH DETAILED
RATIONALE FROM THE APPROPRIATE AREA LISTED BELOW (SEE BACK FOR EXAMPLES)
The program leader/division coordinator of the student’s declared major
If applicable, a faculty in the appropriate department for substitutions or requirement
alternatives
RCTC Counselor for liberal arts, transfer, and 2+2 students in collaboration with
appropriate program leaders/division coordinators
A FULL LISTING OF RCTC FACULTY/PROGRAM LEADERS/DIVISION COORDINATORS/
ADVISORS CAN BE DOWNLOADED FROM:
http://www.rctc.edu/counseling_career_center/html/advisors.html
Academic Standards Committee Action
___Approve ___Deny Signature________________________________ Date_________________
9/03 (Revised 09/10/09)
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