Fillable Late Add Petition- Form DVC (Los Medanos College)

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Late Add Petition- Form DVC (Los Medanos College)

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LMC Pittsburg Office (925) 439-2181 ext. 7500
LMC Brentwood Center (925) 513-1625
Revised 7/21/10
Late Add Petition
Instructions:
1. Students will use this form for late registration after the last day to add a course if they did not enroll during
the registration or late add period.
2. The petitioning student must take this form to Admissions & Records no later than 5 business days after
the census date for approval and registration into the course.
To Be Completed by Student:
Student Name: __________________________________________________ Student ID: _______________
Last Name First Name Middle Initial
Phone: ________________________ Email Address: ____________________________________________
Please indicate which term: Summer Fall Spring Year 20______
List Course:
Course Name
Course Number
Section Number
Units
Instructor Name
Detailed reason for registering after the deadline: ________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
____________________________________________________ __________________________________
Student Signature Date
To Be Completed by the Instructor:
Recommend approval Recommend Disapproval
List Census Date for Course: __________________ Student’s First Date of Attendance: _________________
List reason for recommendation of Approval: ____________________________________________________
________________________________________________________________________________________
____________________________________________________ __________________________________
Instructor Signature Date
To Be Completed by the Approving Manager (Dean or A&R Director):
Approved Denied
Comments: ______________________________________________________________________________
____________________________________________________ __________________________________
Manager Signature Date
Office Use Only:
Posted By:____________________________________ Date _____________________________________
Census Date: ________________
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Late Add Petition- Form DVC (Los Medanos College)

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Completed 21 July 2020

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