10/2019 – Office of Admissions
FOR OFFICE USE ONLY Logged:
Processed By:
Approved Denied No Action Notice Sent:
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 10-15 working days.
I request: (Check appropriate box and explain below in detail).
Academic Credit: (Military, Police Academy)
Enrollment Error: Semester Course Section#
Replacement of AA Degree Certificate :____________________________________(Replacement fee $10)
Pass/No Pass request: Semester_________________ Course_____________________ Section#___________________
(Allowed first 6 weeks of Spring/Fall and first week for Winter/Summer) (Please review catalog for information regarding Pass/No
Pass guidelines) (In accordance with Title 5, Section 55752).
Other: ______
Reason\Problem: BE SPECIFIC - Attach copies of all pertinent documents. (Use reverse side if additional space is needed)
__________________________________________________________________________________________________
__________________________________________________________________________________________________
_________________________________________________________________________________________________
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:
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