Course Re-evaluation Appeal
Please type or print in ink.
Name Palm Beach State Student ID#
Mailing Address Phone Number
City State Zip
Each request must include:
• Completed Course Re-evaluation form
• Catalog description of the course to be re-evaluated
• Course syllabus (if possible)
• Listing of General Education courses at below college/university
*Student will be notified by mail as to the result of your re-evaluation request.
Name of Transfer Institution _________________________________________________________________________
(One form per institution)
TRANSFER INSTITUTION PALM BEACH STATE EQUIVALENT
Explain your reasons for submitting this appeal, and why you believe your request is justified. Be specific and be detailed.
Attach any documentation that supports your appeal to this form. Use the back of this form, if necessary, or attach any
additional pages.
Signature Date
College Registrar’s Office 4200 Congress Avenue Lake Worth FL 33461
