Fillable General Petition Return Completed form to Admissions@mccd.edu (Merced College)

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General Petition Return Completed form to Admissions@mccd.edu (Merced College)

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The General Petition Return Completed form to Admissions@mccd.edu (Merced College) form is 1 page long and contains:

  • 2 signatures
  • 11 check-boxes
  • 23 other fields

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File type: PDF

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General Petition
Return Completed form to Admissions@mccd.edu
Rev. October 2020
I request the Petitions Committee to consider this petition in the category checked below:
☐ Late Request for Graduation
☐ Late Request for P/NP (Pass/No Pass)
☐ Drop without “W”
☐ *Refund/Tuition Credit on Student Account
☐ 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
* Petition Outcome will be emailed to MC Portal email or email written above, if legible.
White Copy – Admissions & Records Office
Counselor’s Signature
Counselor’s signature will help to insure
the petition is filled out correctly.
Last Name
First Name
Student ID # or Social
Security # (One required)
Date
Address
City
Zip
E-Mail Address
Daytime Phone Number
Current Goal / Major
Semester (Spring, Summer, Fall)
Year
Course(s)
Effective
Date:
_________________
Rebill Account
Yes ____ No____
* Tuition credits will remain on your account. If you would like a refund of over paid fees, please fill
out a refund request form (https://www.mccd.edu/resources/fees/forms.html) with the Student
Fee’s office and setup your eRefund account on your portal. (Instructions: https://www.mccd.edu/
resources/fees/payments.html)
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General Petition Return Completed form to Admissions@mccd.edu (Merced College)

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Completed 27 November 2021

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