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:
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 ________________
