Course Time Conict Approval Peon
Admissions and Records
2300 E. Gibson Road, Woodland, CA 95776
(530) 661-5700
Date: Fall: Spring: Summer: 20:
Student Name: Student ID#::
Student Instrucons:
Enrollment in courses that have a me conict is prohibited by state regulaons except in cases where there are ex-
tenuang circumstances (scheduling convenience is not acceptable). If you believe you have an extenuang circum-
stance and wish to peon to take a course that conicts in me, you must discuss your situaon with the instructor
of the class in which you will “miss” the regularly scheduled me. All secons of this form must be lled out and signed
by the student and instructor. Submit the form to the Admissions & Records Oce. The form will then be submied
to the Dean of Instrucon/Learning Resources for nal approval. Make sure to turn in the peon prior to the dead-
line to add classes. Peon decisions can take between *5-7+ working days for review.
In courses (other than television/media), the student must make arrangements with the instructor to make up the
hours of overlap/conict at some other me during the same week that me was missed.
Regular (non television/media) class: I am peoning to take two Yuba Community College District classes at overlap-
ping or conicng mes. I have read the informaon above and will make arrangements with the instructor to make
up the hours missed at some other me during the same week the me will be missed.
To be completed by student:
My extenuang circumstance for this request is (scheduling convenience is not acceptable per California Title 5
regulaon):
Date Signed Student Signature
Class Code Dept & No. Title of Class Instructor Days Check Class To Be
Made Up
Weekly Time To
Be Made Up
Times of Class
(EXAMPLE): 3524 MUSIC 15 Popular Music in the US J. Abigana MW
x
15 minutes 4:00PM-5:15PM
(EXAMPLE): 3460 ENGL 51 Preparatory Comp and Read T. Schmits MW
5:00PM-6:50PM
Oce Use Only: Television/Media Course Regular Course
REV. 2/11
Please see reverse for
further instrucons
click to sign
signature
click to edit