GENERAL PETITION
IT IS VERY IMPORTANT THAT YOU READ ALL INFORMATION CAREFULLY BEFORE COMPLETING
THIS
FORM: The Admissions Office does not mediate instructor/student issues. Students are responsible for observing all
Add and
Drop dates. Explain clearly your request and attach appropriate documentation where required. Please check the
type of Petition you are requesting. Fo
r a detailed explanation of the types of Petitions, see the backside of this form. General
Petitions are processed within 2-6 weeks. During peak periods this process may take longer. You will be notified by email or
USPS.
Default Grade: Receive the default grade for an incomplete course by waiving the one year make-up period.
Health Fee Exemption: Petitions fees you have incurred based on documented type of exemption. (See back for types)
Pass or No Pass: See current Schedule of Classes for eligible courses an
d deadline date. P or N posted to transcript.
Other: Errors made by the Admissions Office.
Semester and Year Semester and Year
Course Name and Number Course Name and Number
Section Number Section Number
Last Name First Name Middle Initial SID or SS Number
Other Names Used Date of Birth Telephone Number
Address City State Zip LACCD Email Address
Explain clearly your request and attach appropriate documentation where required:
Student Signature_______________
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Request for EW: Military Withdrawals, Medical & Legal Matters within the semester, etc.
(Must provide documentation)
click to sign
signature
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General Petition
Give a full statement of what the request is and the reason for the request. As appropriate attach any supporting
documentation (i.e. Physician Letter, Military Orders, Police Reports, and Legal Documents) or evidence that supports your
request. Priority is given to students with documentation. Petitions may take up to 6 weeks to investigate without
supporting documents.
Default Grade
Student received an “Incomplete” for a class. Student agrees to waive the one-year make-up period and accept the default
grade.
Health Fee Exemption
According to Education Code 76355 and the Los Angeles Community College Board Rule 8502 exemption from the
payment of health fees are: (a) students who depend exclusively on prayer for healing in accordance with the teaching of a
bona fide religious sect, (b) students who are attending classes under an approved apprenticeship training program, (c)
noncredit education students, (d) students enrolled in District colleges exclusively at sites where student health services are
not provided, (e) students who are enrolled in District colleges exclusively through Instructional Television or distance
education classes, (f) students who are enrolled in District colleges exclusively through contract education, (g) students
admitted as Special Part-time Students (K-12) or Special Summer School Students under the provisions of Board Rule
81001.01 or 81001.02
Pass/No Pass
A form of grading whereby a student receives a grade of Pass (P) or No Pass (NP) instead of an A, B, C, D or F. A “P” is
assigned for class work equivalent to a C or above. “NP” denotes work below a grade of C. Students may petition courses
for Pass/No Pass within the first six weeks of the semester. The list of approved courses is listed in the current Schedule of
Classes and College Catalog. Students that have received credit on a Pass/No Pass basis may not convert the credit to a
letter grade. The maximum number of units a student may petition for is 15.
FOR OFFICE USE ONLY
Granted Denied Postponed No Action
Comments/Conditions:
Student Notification: Email USPS Signature: Date:
RVSD: May 2019
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