Fourth Attempt Petition rev 10/16/2018 Page 1 of 2
Fourth Attempt Petition
Spring/Fall Semesters Only
Name: Student I.D. #:
Last First M.I.
Address: Date of Birth:
Number Street Apt. #
Email: _
City State Zip Code Phone Number:
Fourth Attempt: A student may enroll and receive an evaluative symbol of “D, F, NCR and NP” and/or a non-
evaluative symbol of “W” in the same credit course a maximum of three times. Title 5 Regulation 55024 allows a
district to establish a petition process for students attempting this same course a fourth time due to extenuating
circumstances.
Extenuating Circumstances: According to Board Rule 6701.10, “Extenuating circumstances may include, but are
not limited to, verified cases of accidents, illness, military service, significant lapses of time, changes in program or
major, or other circumstances beyond the control of the student.”
Filing Periods: (Fourth Attempt Petitions will be considered for spring/fall semesters only).
• Spring semester: October 1 to December 21
• Fall semester: April 1 to June 1
Provide the following information for the course and semester in which you wish to enroll:
SEMESTER / YEAR
Spring/Fall
Required steps and documentation (Incomplete petitions will not be accepted):
Step 1 - Use the reverse side of this form to:
A. State the reason(s) for each substandard grade and/or frequent withdrawal in the course you wish to
repeat.
B. Explain what measures you will attempt to improve your academic performance in this course.
Step 2 – Meet with a counselor to obtain a Comprehensive Student Educational Plan (SEP).
Step 3 - Attach the Comprehensive Student Education Plan (SEP) and documents to verify and support your
reason(s) for each substandard grade and/or frequent withdrawal. Note: Official documentation is
critical to the review and approval process.
Step 4 - Submit all documents, within the filing period dates, to the Office of Admissions, E1-105.
After committee review, the Office of Admissions and Records will mail the committee’s decision to the student within
15 calendar days after the decision is made. Approved students are allowed to register in-person only in the Office
of Admissions, E1-105, during the first week of the term. Must bring permission number or add permit.
