Academic Forgiveness Petition
Anoka Technical College is an affirmative action, equal opportunity employer and educator, and a member of the Minnesota State Colleges and Universities system.
This document is available in alternative formats to individuals with disabilities by calling -763-576-4700, TTY: 7-1-1 or 800-627-3529. 01/17
1355 West Highway 10
Anoka, MN 55303
763-576-4700
AnokaTech.edu
(Please submit form to Academic Affairs)
Student Name _______________________________ Student ID ________________________
Student Phone Number _______________________ Student Email ______________________
Courses to be forgiven:
Semester and year taken
Course prefix and number
Course name
Number of credits
Grade
Rationale for Academic Forgiveness (Include reasons for past poor performance and what has
changed. Attach another sheet of paper if necessary.):
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I have read and understand the conditions outlined in the Academic Forgiveness Policy found:
http://www.anokatech.edu/en/AboutATC/PoliciesProcedures/Policy211AcademicForgiveness.aspx
and I request that my academic record be reviewed.
Student Signature _____________________________________ Date ____________________
Students will be notified of decision via email within 30 calendar days of submission.
Office Use Only:
Currently accepted to a major and attending
24 month break prior to readmission
12cr completed with 2.0 GPA (CUM GPA since readmission)
Petition submitted within one year of completing 12cr since readmission
Action: ____ Denied ____ Approved Comments: ___________________________________________
Academic Dean Signature _________________________________________________ Date____________
Date student notified ____________________ If approved, Registrar entered into ISRS ________________
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