Fillable Form 4231.: STUDENTS PETITION TO CHANGE GRADE TO (Ventura College)

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Form 4231.: STUDENTS PETITION TO CHANGE GRADE TO (Ventura College)

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ADMISSIONS & RECORDS OFFICE
4667 TELEGRAPH ROAD, VENTURA, CA 93003 PHONE: (805) 289-6457
Section 1: Petition for: Spring 20____ Summer 20____ Fall 20____
A&R 3/19/20
STUDENT’S PETITION TO CHANGE GRADE TO WITHDRAWAL
Student Name: ________________________________________________________ Student ID: 900________________
Email (Optional): __________________________________________________ Phone Number: (______) ________ - ___________
Course Name & Title: __________________________________ CRN: _________ Withdrawal Deadline: _______________
Justification for Request (Student must provide supporting medical, legal, or other appropriate documentation dated for the term in
question. If supporting documentation is not provided, petition cannot be approved): ______________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Student Signature: ____________________________________________________ Date: _________________
Comments: __________________________________________________________________________________________________
Instructor Name (Print): ________________________________________________
Instructor Signature: ___________________________________________________ Date: _________________
Comments: __________________________________________________________________________________________________
Dean Name (Print): ____________________________________________________
Dean Signature: _______________________________________________________ Date: _________________
POLICY
Policy: Per VCCCD AP 4230, withdrawals shall not be permitted after the 14
th
week of a full-semester length course or 75% of total class
meetings in a short-term course. In order for an exception to be permitted, a petition must be submitted and the student must provide
documentation of verifiable extenuating circumstances. A petition is considered only in cases of verified accident, illness, or other
circumstances beyond the control of the student.
Grade changes can be requested by the student no more than three (3) years after the term in which the grade was awarded, per VCCCD AP
4231.
A change of academic grade to Withdrawal (W) will be recorded only after this petition has been completed, signed by the student, approved
by the course Instructor and Division Dean, and determined to meet the requirements of the policies of the Ventura County Community
College District.
Section 2: Instructor Approval Approved Denied
Section 3: Division Dean Approval Approved Denied
A&R Office Use Only: APPROVED DENIED Initial: _______ Date: _______ Student Notified (Initial): _______ Date: _______
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Form 4231.: STUDENTS PETITION TO CHANGE GRADE TO (Ventura College)

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Completed 6 September 2020

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