Fillable General Petition (Merced College)

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General Petition (Merced College)

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  • 19 other fields

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File type: PDF

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General Petition
White Copy – Admissions & Records Office Rev. August 2017
I request the Petitions Committee to consider this petition in the category checked below:
☐ Late Request for Graduation ☐ Drop without “W”
☐ Late Request for P/NP (Pass/No Pass) ☐ Refund
☐ Other ___________________________________________________________________
Please provide information the committee should consider in making a decision. Be sure to submit verification of
your extenuating circumstances and to include course(s), semester and instructors’ names, if applicable. Attach
additional information if necessary.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Petition must be complete for it to be considered. Failure to provide official documentation may result in denial.
Allow up to 4 weeks for committee decision.
____________________________________
Student’s Signature
DO NOT WRITE BELOW LINE
Action taken by committee:
☐ Petition Approved ☐ Petition Denied ☐ No Documentation Provided ☐ Other
Comments: ________________________________________________________________________________________
_______________________________________________ ___________________
Chairman, Petitions Committee Date
* Fee refund will remain as a credit on your account.* If you would like a refund mailed to you please fill out a
request for a refund slip in the Student Fee’s office. Outcome will be emailed to MC Portal email or email written
above, if legible.
Counselor’s Signature
Counselor’s signature will help to insure
the petition is filled out correctly.
Last Name
First Name
Date
Address
City
State
Zip
E-Mail Address
Daytime Phone Number
Current Goal / Major
Semester (Spring, Summer, Fall)
Year
Course(s)
Effective
Date:
_________________
Rebill Account
Yes ____ No____
Your response will be
sent to your email above.
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General Petition (Merced College)

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Completed 5 September 2020

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