Fillable CO/PREREQUISITE CHALLENGE FORM (Palo Verde College)

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CO/PREREQUISITE CHALLENGE FORM (Palo Verde College)

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PALO VERDE COLLEGE
CO/PREREQUISITE CHALLENGE FORM
Name SSN Phone
Street Address City/State/Zip
COURSE I WISH TO ENTER:
Course Code: Section:
CO\PREREQUISITE OR COURSE REQUIREMENT I WISH TO CHALLENGE:
Course Code: Section:
Please explain your request in detail on the back of this form: (If you have checked box #4, include a copy of your
assessment results)
After obtaining the appropriate signature, submit this form, documentation, and your Student Schedule Change
card to your Counselor, five days prior to the last day to register.
Documentation for summer sessions and short
courses must be submitted two (2) days before the last day to register. It is the responsibility of the student to provide
compelling evidence to support the Challenge
(ATTACH DOCUMENTATION).
A denied petition may be appealed to the Petition Review Committee in the Student Services Office.
*Waiver of a co/prerequisite course will not result in credit/units being granted in the waived course.
Signatures: Student Date Submitted
Check the box which applies to you:
[ ] 1. Challenging the co/prerequisite on the grounds that it has not been made reasonably available.
The
petition must be taken directly to the Dean of Instruction who shall determine within five (5) working days whether the
co/prerequisite course was reasonably available, and if not, shall waive the co/prerequisite for the term.
The documentation has been evaluated and the Challenge is approved [ ] disapproved [ ].
VP of Instruction: Date
[ ] 2. Challenging the co/prerequisite on the grounds that it was established in violation of regulation or in
violation of the District-approved processes (student documentation required).
I understand that I must
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take the petition directly to the Dean of Instruction who shall review the petition and provide written notification to the
student within five (5) working days.
The documentation has been evaluated and the Challenge is approved [ ] disapproved [ ].
VP of Instruction: Date
[ ] 3. The co/prerequisite is discriminatory or applied in a discriminatory manner (student documentation
required). I
understand that I should present documentary evidence to the Affirmative Action Officer who will review
the evidence and provide written notification to me within five (5) working days.
The documentation has been evaluated and the Challenge is approved [ ] disapproved [ ].
Affirmative Action Officer: Date
[ ] 4. Challenging the co/prerequisite based on my knowledge or ability to succeed in the course despite not
meeting the co/prerequisite (student documentation required).
(I am) challenging the co/prerequisite based on my knowledge or ability to succeed in the course despite not
meeting the co/prerequisite. I understand that I must take the petition directly to the any full time Instructor in the
Division. I also understand that I must demonstrate my ability to succeed in the course which I am petitioning to
take out of the ordinary sequence, and that the Instructor will administer a Division approved
(See reverse)
challenge assignment, which may include a validated exam, an essay, or other demonstrations of my ability, as
deemed appropriate by the academic Division, and that assignment must be evaluated by more than one member
of the Division or a closely related Division if no other Division members are available. I understand that I must
pass the challenge assignment before I will be allowed to take the course I am challenging.
This documentation has been evaluated and the Division has administered a challenge assignment, as approved by
the Division and evaluated by more than one Instructor within the Division or a closely related Division.
The student
’s Challenge is
____ a) approved
____ b) not approved
Signature ___________________________________Date _____________
Name (printed)_____________________________
(title) ______________________________________
Signature___________________________________ Date _______________
Name (printed) ____________________________
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(title) ______________________________________
[ ] 5. Challenging the co/prerequisite based on Undue delay in attaining goal (55201(f) (5).
The documentation has been evaluated and the Challenge is approved [ ] disapproved [ ].
Counselor: Date ______________________________
[ ] 6. Challenging the co/prerequisite based on other grounds as established by governing board 55201 (f) (6).
VP of Instruction: Date
FOR STUDENT USE:
FOR PETITION REVIEW COMMITTEE USE ONLY:
The documentation has been evaluated by the Petition Review Committee and determined that the student does [] does
not [ ] have the equivalent knowledge or ability. Challenge is approved
[ ] disapproved [ ].
VP of Student Services Signature
Date_________________________
Committee Member Signature and Title
Date_________________________
Committee Member Signature and Title
Date_________________________
Committee Member Signature and Title
Date_________________________
Committee Member Signature and Title
Date_________________________
Action taken: Date
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Comments:
CHALLENGE/REVISED mg March, 2007
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COPREREQUISITE CHALLENGE FORM (Palo Verde College)

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Completed 5 September 2020

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