Admissions & Records October 2018 Page | 1
FOLSOM LAKE COLLEGE FOLLOW INSTRUCTIONS ON PAGE TWO
Student Petition
Student ID Number
(A&R Staff Only)
Please complete the following. PRINT legibly and clearly.
Received by/date:
NAME DATE
DAY PHONE *Students will be notified of petition outcome via your LRCCD Email Address.*
① Action Requested (please check) Semester/Term Applicable: Summer
Fall
Spring
Year:__________
Drop with No Notation Drop with Excused or Military Withdrawal Drop with W Notation Drop for Refund
Other (Pass/No Pass grading after deadline, late degree petition, leave/catalog rights, refund after end of term) ________________
______________________________________________________________________________________________________________
Course Information (see instructions)
Class Number
(e.g. 20234)
Course Title
(e.g. BIOL 430)
Instructor Signature
(REQUIRED FOR DROPS, PASS/NO PASS)
Student’s Last Day of Attendance/Participation
(REQUIRED-Completed by Instructor)
Student’s Justification of Request (Be specific and attach supporting documentation.)
_________________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________
Student’s Signature Date
Required Additional Signature (see instructions on other side):
FOR DROPS AFTER DEADLINEAREA DEAN RECOMMENDATION -
Recommend Do Not Recommend Area Dean’s Signature/Date ___________________________
Administrator Use Only
Petition has been reviewed and request has been: No Action Taken Approved Denied
Administrator’s Signature Date
Processed E-mailed
Action Taken Processor’s Initials/Date & Comments
Admissions & Records October 2018 Page | 2
Student Petition Instructions
P
URPOSE OF THE FLC STUDENT PETITION
Th
e Student Petition provides students an opportunity to request action that is normally not permitted by state law, district
policy or college practices and procedures. See the FLC Catalog for policies related to your request. Deadline dates are
mandated by the State of California and are not arbitrarily set by the college. Consideration of exceptions to policy is,
therefore, a very serious matter. Not being aware of the deadline is not an acceptable reason for seeking an exception.
Students must take personal responsibility for adhering to all published dates.
Drop Deadlines as set forth in Title 5 and Los Rios board regulation:
WITHDRAWAL (W)
Withdrawal from a class or classes shall be authorized by the following conditions:
Students who withdraw from class during the first 15% (see academic calendar) of the term will have no notation
made on their permanent record.
Students who withdraw from class between the 15% and 75% (see academic calendar) of the term will have a “W”
entered on their permanent record.
After 75% of the term, students shall receive one of the following grade symbols: A, B, C, D, F, P, NP, or I.
Under extenuating circumstances, students may petition to withdraw from class(es) after the 75% of the term.
EXCUSED WITHDRAWAL (EW)
Students can petition for Excused Withdrawal (EW) when the withdrawal from a class is due to specific events beyond the
control of the student affecting his or her ability to complete a class. These events may include a job transfer outside the
geographical region, an illness in the family where the student is the primary caregiver, when the student who is
incarcerated in a CA state prison or county jail is released from custody or involuntarily transferred before the end of the
term (not including if failure to complete class was result of student’s behavioral violation or at student’s request), when
the student is the subject of an immigration action, or other Extenuating Circumstances. Excused Withdrawal shall not be
counted in progress probation and dismissal calculation and will not count as an attempt. Effective Fall 2018 EW is not
retroactive and is not eligible for refund.
MILITARY WITHDRAWAL (MW)
Students can petition for Military Withdrawal (MW) when an active duty military or reservist has received orders to transfer
in accordance with Section 55024 of Title 5. Upon verification of orders, the MW shall not be counted in progress probation
and dismissal calculations, will not count as an attempt and the student is eligible for a refund of enrollment fees.
DEFINITION OF EXTENUATING CIRCUMSTANCES: Verified cases of accidents, illnesses, or other circumstances beyond the
student’s control.
INSTRUCTIONS
Complete student information section at top of petition and Sections ①, ② (Class Number and Course Title),
(be specific and attach supporting documentation, especially for petition for EW or MW), and Section
if
p
etition is for Drop after Deadline (Area Dean recommendation/signature).
For Section , if the action request is a Drop after Deadline, you must obtain instructor signature along with
notation of your last date of attendance/participation. If unable to obtain in person, an email from the instructo
r
with the required information using their Los Rios email address will be accepted.
For EW or MW, appropriate documentation such as military orders, doctor’s note, etc. is required.
P
lease turn in student petition to the FLC Admissions & Records office, or at the Student Services offices at EDC or RCC.
PLEASE NOTE: You will be notified by e-mail of action taken within 5 business days after you have submitted your
Petition.