San Jose City College
Extended Opportunity Program & Services
Date: ________________ Semester: ______________________
Name: _____________________________________________ I.D #: ________________________
Last Name First
Phone Number: ( ) ___________________ E-mail: ________________________________
Please explain the reason for what you are petitioning:
New student trying to get accepted into the program Completed over 70 units
Academic Progress (failed to complete 75% of classes)
Failed to complete mandatory appointments. Other: Please explain: _____
Please explain how will you improve your academic progress and/or comply with the Mutual
Responsibility contract this semester.
(Please use the back of this page if needed)
Student Agreement
I will not receive a W, NC, or INC in any of my classes
I will pass all my classes with a C or better this semester
I will keep my three (3) appointments with an EOP&S counselor this semester
__________________________________ ___________________
Student Signature Date
Petition: Approved Denied Comments: ______________________________
Award: Full Grant Half Grant No Grant
_________________________ ______________________ _________
Signature Title Date
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