April 2011
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.
Name:
First
Middle
Last
Mailing Address:
P.O. Box or Street, Apt. #
City
State
Zip
Student ID Number:
Local Telephone Number: Major:
Reason for Petition:
Academic Probation (limited to 16 credits)
Extended Academic Probation (limited to 7 credits)
Course Overload
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.
Grade Change
o To be filed within six months of the close of semester in which grade
was received.
o To be filed only after the student has discussed the grade in question
with the instructor and the division chair.
Prerequisite Override
Residency Classification
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
Other
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
Credits
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
College Official/
Committee Chair:
Date:
Units passed last semester: GPA: Denied
Cumulative Units: Cumulative GPA:
Comments:
Verification:
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