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Admissions & Records Office (Evergreen Valley College)

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Admissions & Records Office
3095 Yerba Buena Road San Jose Ca 95135
408.270.6423 office / 408.223.9351 fax / evcar@evc.edu
email
General Petition Form
Last Name ________________ First Name _____________________ Date of Birth _____________
Address __________________________________________ Telephone _
___________________
Student ID or Last 4 SSN ___________________
Graduation Appeal YES NO
State the purpose of the petition including statements of facts, reasons, events, or circumstances to support petition. Attach
supporting documentation when applicable.
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_
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Signature ____________________________ Date _______________________________
APPROVED DENIED PENDING
Signature ____________________________ Student Notified Date ______________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_
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FOR OFFICE USE ONLY
REV 8/17/16
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Admissions & Records Office (Evergreen Valley College)

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Completed 25 July 2020

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