Fillable FillablePetitionAppealPetition04252017nb Expected semester of graduation (check one)

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FillablePetitionAppealPetition04252017nb Expected semester of graduation (check one)

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Student responsible for understanding information on all pages of documents. Page 1 of 2
Updated: 04/25/2017 NB
Filename: OAR(\\Ishtar)/A&R Forms-Petitions-Appeal Petition Please return to A&R for processing
Admissions and Records Rec’d By:
Appeal Petition Date:
Petition refers to:
______________________________________________ Fall 20 _______
Petition or Policy you wish to Appeal
Spring 20 _______
Summer 20 _______
______________________________________________ ___________________________________________
Student Name Date of Birth
______________________________________________ ___________________________________________
Mailing Address SCC Email Address
______________________________________________ ___________________________________________
City State Zip SCC ID#
Explain why you feel original outcome was inappropriate and why you think your request should have been approved:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
____________________________________________________________________________________________(attach additional sheet if needed)
________________________________________________________________________________________________
Student’s Signature Date Telephone No.
Attach all applicable supporting documentation.
Academic Council Review
Date Reviewed:_____________ Appeal Approved: Y N
Council Determination
:________________________________________________________________________________
________________________________________________________________________________________________
Council Chairperson or designee: _____________________ ________________
(initial) (Date)
Subtract from Apportionment? Y N
If Yes, marked in Banner? _______ _____________________ ________________
(initial) (Date)
Student Notified? Y N _____________________ ________________
(initial) (Date)
RESET FORM
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Student responsible for understanding information on all pages of documents. Page 2 of 2
Updated: 05.14.14 dlw
Filename: OAR(\\Ishtar)/A&R Forms-Petitions-Appeal Petition
Please return to A&R for processing
Appeal Petition Information and Instructions
If you wish to appeal the outcome of a previously processed petition, policy or practice it
is appropriate to complete this form.
Before completing this form students are urged to make at least one additional
attempt at resolution with the department that first denied the original petition.
Instructions:
1. Complete this form
2. Submit to Admissions & Records
3. Initial review will be completed and student will be sent a copy reflecting
determination via SCC email within ten (10) business days after the Academic
Council meets.
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Completed 5 November 2019

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