Fillable ECP FORM EXTENUATING CIRCUMSTANCES PETITION (Norco College)

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ECP FORM EXTENUATING CIRCUMSTANCES PETITION (Norco College)

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3/19/20 10:11 AM
Admissions & Records
Extenuating Circumstances Petition
Extenuating circumstances are verified, documented cases of accidents, illnesses, or other circumstances beyond the
control of the student. Students have one year following the semester in which the grade was recorded to submit this
petition. This petition is a formal request for an exception to, or waiver of college procedures.
Name: _____________________________________________________________ RCCD ID: _____________________
Last Name First Name Middle Initial
Address: ______________________________________________ _______________________ _____ ____________
Number and Street Apt# City State Zip
Phone: (________) ________________________ Student Email: ____________________________________________
This petition, whether approved or denied, may affect your obligations as a financial aid, scholarship or loan recipient. If you are an
applicant and recipient of assistance you need to inform Student Financial Services and obtain a signature.
Are you currently on Financial Aid? YES NO
Did you receive financial assistance during the semester you petitioned? YES NO
If you answered YES to any of the above questions you must obtain a signature from Student Financial Services.
_______________________________________ _______________________________________ _________________
Student Financial Services Signature Title/College Date
NO PETITION WILL BE CONSIDERED WITHOUT DOCUMENTATION
Clearly state your request and explain the extenuating circumstances in as much detail as possible. If necessary,
please use additional paper.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Student Signature: ________________________________________________________ Date: ___________________
**** ALLOW AT LEAST 6 TO 8 WEEKS FOR PROCESSING. THE RESPONSE WILL BE MAILED TO YOU. ****
********************************* ADMISSIONS & RECORDS OFFICE USE ONLY ********************************
Approved Disapproved Comments: ______________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
___________________________________________________________________ _____________________________
Dean, Enrollment Services Date
Please list specific course information, incorrect or missing information may delay your petition:
________________________________ ____________________ _________________ ______________________
College Class Title (e.g., ENG-1A) Five-Digit Section Number Semester and Year (e.g. Spring 2019)
Refund Remove W* Change grade from F to W Request EW (Excused Withdrawal) Remove F
Other: ______________________________________________________
*W's may not be removed if student attended more than 20% of the course.
Faculty Recommendation: Approve Disapprove Last Date of Attendance: _______________________
Comments: _____________________________________________________________________________________
______________________________________________________________________________________________
____________________________________________ _______________________________ _________________
Instructor/Department Chair/Dean of Instruction Signature Title Date
A&R Staff:
Date Received: _____________________
A&R Staff Initials: ____________________
ID Verified: YES NO
Documentation: YES NO
Meets One-Year Deadline: YES NO
SFS Signature: YES NO
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ECP FORM EXTENUATING CIRCUMSTANCES PETITION (Norco College)

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Completed 2 February 2021

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