Course Time Conict Approval Peon
Admissions and Records
2300 E. Gibson Road, Woodland, CA 95776
(530) 661-5700
Date: Fall: Spring: Summer: 20:
Student Name: Student ID#::
Student Instrucons:
Enrollment in courses that have a me conict is prohibited by state regulaons except in cases where there are ex-
tenuang circumstances (scheduling convenience is not acceptable). If you believe you have an extenuang circum-
stance and wish to peon to take a course that conicts in me, you must discuss your situaon with the instructor
of the class in which you will “miss” the regularly scheduled me. All secons of this form must be lled out and signed
by the student and instructor. Submit the form to the Admissions & Records Oce. The form will then be submied
to the Dean of Instrucon/Learning Resources for nal approval. Make sure to turn in the peon prior to the dead-
line to add classes. Peon 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/conict at some other me during the same week that me was missed.
Regular (non television/media) class: I am peoning to take two Yuba Community College District classes at overlap-
ping or conicng mes. I have read the informaon 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 extenuang circumstance for this request is (scheduling convenience is not acceptable per California Title 5
regulaon):
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
Oce Use Only: Television/Media Course Regular Course
REV. 2/11
Please see reverse for
further instrucons
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DAYS
TIMES
WEEKLY
TIME MADE
UP
COMMENTS
(EXAMPLE):
Wednesdays
(EXAMPLE):
7:00-
7:10PM
10 Minutes
(EXAMPLE): Student will meet with me for 10 minutes aer
class to review coursework missed in class.
TO BE COMPLETED BY INSTRUCTOR OF OVERLAPPING CLASS:
If the student provides sound juscaon and if you are willing to allow this student to enroll in a course
that conicts with your course, please document how and when the me missed from your course will be
made up by this student. Per Title 5-secon 55007, the college requires “documentaon describing the jus-
caon for the overlapping schedule and showing that the student made up the hours of overlap in the
course parally or wholly not aended as scheduled at some other me during the same week under the
supervision of the instructor of the course.”
Instructor Use Only:
In order for the college to receive FTES funding for this student’s enrollment in your class, the college may
permit the overlapping schedule if (a) raonal juscaon (scheduling convenience is not acceptable) on a
student-by-student basis can be established and is documented by the faculty and (b) the faculty maintains
documents that the student made up the hours of overlap in the course parally or wholly not aended as
scheduled at some other me during the same week under appropriate supervision (see below).
Instructor of Overlapping Class - Print Name
Date Signed Instructor of Overlapping Class - Approval Signature
Acon of the Dean of Instrucon/Learning Resources:
Approved Denied
Date Signed Dean of Instrucon/Learning Resources - Approval Signature
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signature
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signature
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