General Petition for Exceptions to Catalog or Policy Requirements
Use this form to petition for exceptions to Catalog or Policy requirements. If you have questions, please contact Records and Registration
Office at (928) 428-8270 or (800) 678-3808, Ext. 8270.
P.O. Box or Street, Apt. #
Student ID Number:
Local Telephone Number: Major:
Academic Probation (limited to 16 credits)
Extended Academic Probation (limited to 7 credits)
Test for Credit (Credit by Departmental Exam)
Credit For Apprenticeship Training, Licensing, or Other Agency
Training or Examination
o Include copy of license, training, etc.
o To be filed within six months of the close of semester in which grade
o To be filed only after the student has discussed the grade in question
with the instructor and the division chair.
o To be filed only after residency has been denied
through Records and Registration.
Substitution in Requirement
Underage Petition (under 14 years of age)
Withdraw Without Record
If a Course Overload, Academic or Extended Academic Probation, please list the courses over the limited amount you would like to add:
Course Prefix/ Course Number
Explanation of Petition – Please state your request and list all relevant facts and circumstances. Provide supporting documentation.
(Use back of the form for further explanation, if needed)
For Records & Registration Use: For Academic Standards Appeals Committee Use:
Date Received: Date Notified: Approved
Units passed last semester: GPA: Denied
Cumulative Units: Cumulative GPA: