PETITION
FOR
READMISSION
FOLLOWING
ACADEMIC DISMISSAL
Directions
1. Please type
or
print
all
information
clearly.
2.
Provide all information requested.
3. Completed
petition
must
be
submitted
to
the Counselor
by
December 1,
for
Spring Semester readmission
and
July 1,
for
Fall
Semester readmission.
NO
EXCEPTIONS.
4.
A
UH
System online application
must
be
completed.
You
will
be notified by
the
Vice Chancellor
of
Academic Affairs Office regarding
the
final decision.
Date
___________
_
I,
__________________
_,
petition
for
readmission
to
Honolulu Community College
for
Print student's name
________
20_
semester.
My
plan
for
future
success, including a proposed list
of
classes
for
the coming
(Fall
or
Spring)
Semester,
is
shown below (if
more
space
is
needed, continue on
the
back):
I also understand
that
if
granted readmission
to
the
college, I
will
be returning
on
probationary status and
that
if
satisfactory progress
is
not
made, I
will
again be subject
to
dismissal.
Student's Signature
Student Banner
ID#
Current Address
Major
Phone Number(s)
E-mail Address
D Fall
20_
D Spring
20_
D Summer
20_
Counseling Office
to
Attach
STAR
Journey
or
Grad Check / Star Academic Record
or
Advising Document
Counselor
Comments:-----------------------------------
Counselor's
signature/date----------------------------------
I Fo, Office
Use
Only,
ADMISSIONS
___
_
RECORDS
___
_
READMISSION:
D Recommend D
Do
Not
Recommend
Comments:----------------------
-
-----------------
Program Dean's Signature/date
______________________________
_
READMISSION:
D Approved
D Denied
Comments:----------------------------------------
Vice Chancellor
of
Academic Affairs Signature/date
________________________
_
vcaa\petition
for
readmissjon
following
academic dismissal.doc
July 2017
