Admissions & Records July 2014 Page | 1
FOLSOM LAKE COLLEGE FOLLOW INSTRUCTIONS ON PAGE TWO
(A&R Staff Only)
Please complete the following. PRINT legibly and clearly.
NAME DAY PHONE DATE ________________________
*Students must have complete and signed ADD SLIP or LATE ADD PETITION attached. You will be notified of petition outcome via your LRCCD Email Address.*
① Notice to Student: California Education code (also known as Title 5, section 55007) states the following:
(b) A district may not permit a student to enroll in two or more courses where the meeting times for the courses overlap, unless the district has established and
incorporated into its attendance accounting procedures adopted pursuant to section 58030 a mechanism for ensuring that the following requirements are
satisfied:
(1)The student provides a sound justification, other than mere scheduling convenience, of the need for the overlapping schedule;
(2) An appropriate district official approves the schedule;
(3)The college maintains documentation describing the justification for the overlapping schedule and showing that the student made up the hours of the overlap
in the course partially or wholly not attended as scheduled at some other time during the same week under the supervision of the instructor of the course.
1
st
ROW: Complete with information about the class where you will be missing time.
2
nd
ROW: Complete with information about the other class.
(e.g. 11111)
(e.g. BIOL 300)
(e.g M/W/F)
Time of Course
(e.g. Fall 2014)
(print)
Number of minutes weekly that I will
be missing of normal instruction
② Student’s Extenuating Circumstances for Request:
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
I understand that it is my responsibility to fulfill the requirements of each class as I will be receiving full credit for both of them.
Student Signature: _________________________________ Date: _____________________
③ NOTICE TO INSTRUCTORS:
A time conflict between your course and another course of the student’s choice exists. 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) rational justification (scheduling convenience is
not acceptable) on a student by student basis can be established. (b) Faculty maintains documentation that the student made up the hours of overlap in the
course missed, partially or wholly, at some other time during the same week under appropriate supervision. See Education Code listed above. If you are willing
to allow this student to enroll in your course with this conflict (scheduling convenience is not acceptable), check appropriate box below:
I am authorizing the overlapping time conflict in my college class (listed above). I certify that I will make arrangements with the student to make up the
hours of overlap (time not attended) at another time during the same week under supervision. (Note: in a Positive Attendance class, count ALL hours of
attendance for reporting on the Grade Input Roster).
I do not authorize the overlapping time conflict in my college class listed above.
Instructor’s Signature/Date: _____________________________________________
DEAN RECOMMENDATION:
Recommend Do Not Recommend Dean’s Signature/Date _______________________________
Administrator Use Only
Your petition has been reviewed and your request has been: No Action Approved Denied
Administrator’s Signature/Date
Processed E-mailed
Action Taken Processor’s Initials/Date & Comments
