Revised 9/2008 – Office of Admissions
Forwarded To: FOR OFFICE USE ONLY Logged:
Date: Processed By:
Approved
Denied
No Action Notice Sent:
Dean
Evaluator
Dept. Chair
Supervisor
Other:
Signature: Date:
GENERAL PETITION
Office of Admissions and Records
Directions: Completed petition needs to be submitted to Admissions with supporting documentation. Student will be
notified in writing or through email within 10 working days.
I request: (Check appropriate box and explain below in detail).
Academic Credit: (AP, CLEP, Military, Police Academy)
Academic Dismissal Reinstatement
Enrollment Error: Semester Course Section#
Foreign Transcript Credit (Attach original evaluated foreign transcript)
Replacement of
AA Degree
Certificate:
Deans Honor:
(Replacement Degree $20, Certificate $5) Receipt #: Semester/Year
Other:
Reason\Problem: BE SPECIFIC - Attach copies of all pertinent documents. (Use reverse side if additional space is needed)
__________________________________________________________________________________________________
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Student’s Signature__________________________________________Date___________________________
OFFICE USE ONLY
Intake Clerk:
Name: Student ID #:
Last First
Address: Date of Birth:
Number Street
E-Mail:
City State Zip Contact Number:
