Page | 1 SCC | A&R | Blue | Doc. Code AR-0005 | Rev. LBC 3/30/20
Admissions & Records
8045 E. Chapman Ave. E-101, Orange, CA 92869 | www.sccollege.edu
phone: (714) 628-4901 | email: admissions@sccollege.edu
Course Repeat Petition
Student Name: _____________________________________________________ Student ID#: _______________________
(Last) (First)
Phone: _________________________________ E-Mail: ______________________________________________________
By signing or typing my name below I am indicating that I understand that this is the last time that I am allowed to attempt this course at the
Rancho Santiago Community College District (this applies to the first two petition criteria below).
I understand that fees are due and payable at the time of registration if my petition is approved. I understand that once registered, the
transaction may not be reversed. If I choose not to attend the below listed class, it is my responsibility to drop by the established deadline to
receive a refund.
The parties agree that this form may be electronically signed. The parties agree that the electronic signatures appearing on this form are the
same as handwritten signatures for the purposes of validity, enforceability, and admissibility.
Student Signature: ___________________________________________________________ Date: ____________________________
________ ____________________ _____________________________________ ____________________ ____________________________________ _________________________________________________________ ________________________________________________________ ______________________
This appeal applies for the following term: Fall 20____Intersession 20____ Spring 20____Summer 20____
Course Name/Title that you are petitioning to repeat (e.g. ENGL-101): _____________________________
If the reason for your request does not meet one of the criteria below, you are not eligible to petition to repeat the class.
Please mark the type of repeat petition you are requesting:
Third Attempt Course Repeat (third time after 2 substandard grades) You have completed 2 enrollments with
withdrawals/substandard grades. May repeat one last time (Title 5, 55040).
Extenuating Circumstances (fourth time after 3 attempts) See back page for instructions.
Significant Lapse of Time (36 months has elapsed since passing grade and requirement of another institution/program) See back
page for instructions.
Legally Mandated for Training/Employment Student (repeat after passing; required for employment/license) See back page for
instructions.
Completed by Admissions & Records
1) Term/Year ______________________ Grade _________ 2) Term/Year ______________________ Grade _________
(Verified in STAC > STRP) (Verified in STAC > STRP)
Extenuating Circumstances/Legally Mandated for Training/Employment Student ONLY
3) Term/Year ______________________ Grade _________
(Verified in STAC > STRP)
Approved for apportionment. Denied, insufficient documentation.
Denied, per Title 5 regulations, student has exhausted all attempts and no more repetitions are allowed for this course.
Comments: __________________________________________________________________________________________________
Signature: _______________________________________________________________ Date: ____________________________
Assistant Dean, Admissions & Records
(Required for Extenuating Circumstances/Significant Lapse of Time)
Verbally notified student of final attempt: Staff Initials: __________________ Date: _____________________
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Page | 2 SCC | A&R | Blue | Doc. Code AR-0005 | Rev. LBC 3/30/20
EXTENUATING CIRCUMSTANCES (Title 5, 55045, 58161): Student must provide documentation of the extenuating circumstances
(defined as verified cases of accidents, illness, or other circumstances beyond the control of the student). If approved, grades from
last two attempts will be counted in GPA.
Step 1: Attach a separate sheet with your typed responses to the questions below.
a. What are the specific extenuating circumstances and/or causes that led to your lack of successful
completion in your last enrollments?
b. How have your circumstances changed to allow you to earn a passing (non-substandard) grade if
your request is approved?
c. Why do you need to repeat this course to achieve your educational goals (employment, degree/certificate or transfer)?
d. In addition to attending class regularly, completing assignments, and using a tutor, what are the steps
you will take to ensure your success in this course?
Step 2: Attach Required Supporting Documentation (automatically denied without documentation).
Official verification of extenuating circumstances.
SIGNIFICANT LAPSE OF TIME (Title 5, 55040): Received a satisfactory grade for a non-repeatable class. Documentation of recency
requirement from another institution of higher education required. When a course is repeated due to a significant lapse of time, the
previous grade and credit is disregarded in computing the GPA.
Step 1: Has it been at least 36 months since your last satisfactory grade?
If YES, continue to Step 2.
Step 2: Attach Required Supporting Documentation (automatically denied without documentation).
Documentation that shows another institution of higher education to which you seek to transfer has established a
recency requirement which you will not be able to satisfy without repeating the course.
LEGALLY MANDATED FOR TRAINING/EMPLOYMENT STUDENT (Title 5, 55040, Section A8): Received a satisfactory grade for a non-
repeatable class. Official verification from training program or employer required. If approved, grades from last two attempts will be
counted in GPA.
Step 1: Attach Required Supporting Documentation (automatically denied without documentation).
Official verification from training program or employer that requires the student to repeat the class in order to
obtain/renew license or to be employed.