**
:
:
FRESNO CITY COLLEGE
PETITION TO REPEAT A COURSE
NAME:
PHONE #:
EMAIL:
REC’D DATE:
REC’D BY:
S
TUDENT ID:
I AM PETITIONING TO REPEAT:
COURSE t o be Repeated (e.g., PSY-2) TERM Requested (e.g., 2018 Fall)
Fall Spring Summer
Counselor
Intervention Required Due to:
3
rd
Attempt – Counselor Approval Only: Counseling worksheet required (prior attempt earned NP, NC, D, F, W)
4
th
or greater Attempt* OR Repeat of
successfully completed class**
STUDENT MUST SELECT ONE OF THE FOLLOWING JUSTIFICATIONS FOR REPEAT:
Extenuating Circumstances*
Previous NP, NC, D, F, W received was due to verifiable
circums
tances (§55045). (4
th
or greater attempt). Verifiable
Third Party documentation of accident, illness, etc. required.
Legally
Mandated T
raining Req
uired
as a
condition
of
continued
paid or
volunteer
employment
(§55041(b)).
Must
provide do
cumentation
verifying
required training.
Significant
Lapse
of
Time** A si
gnificant
period
of
time has
elapsed
since
course was
successfully
completed
(§55043)
(3 yrs minimum).
Explanation
of and
3
rd
party documentation for repeating course is
required. (Example: Recency requirement of a specific
program or change in industry related technology).
PLEASE N OTE: The grad
e received by repeating the course under any of these circumstances may
not be counted in your GPA. These 3 options require a Comprehensive Student Education
Plan ( SEP) be attached.
Student’s Signature Date
FOR OFFICE USE ONLY
Previous Petitions: YES NO Term: Verified by: STPE Code
List ALL attempts with grades and/or symbols: Fourth attempts and previous successful completion requires
Comprehensive SEP and documentation to be attached.
Has Add Slip from Instructor: SECTION #: AUTH CODE: XADD?
Sent to Counseling: Y
ES
NO Date: Comprehensive SEP Required: YES NO
COMMENTS:
Process Date: By: STPE Code: Copy to Student Date: By:
To ASC: Date: Academic Standards Committee Designee: Date
