ID #
Term/Year:
Phone:
Stud
ents with extenuating circumstances may petition to withdraw from a course(s) with an “EW” grade as of the census date of the
course(s) and no later than 3 years after the end of the term. Typically students are required to drop all courses for the term unless there
is a justifiable reason.
Students petitioning for an excused withdrawal during the drop with a “W” period may do so by dropping the course via Self-Service
and submitting this petition to Enrollment Services.
Stu
dents petitioning for an excused withdrawal after the drop period (75%) will be dropped with an “EW” grade by Enrollment Services,
if approved. If the petition is denied, the grade assigned by the instructor will stand.
Extenuating circumstances are considered specific events beyond the control of the student affecting course completion. The
student must consult with the appropriate Instructor(s) and obtain their signature(s) as part of this petition. Students will be required to
attach documentation to this petition to substantiate the request such as, letters from hospital, physician, law enforcement agency,
attorney, etc.
I request that the grade(s) of “EW” be assigned to the following class(s): Term/Year
COURSE NUMBER SECTION NO. INSTRUCTOR SUPPORT/VERIFICATION (Required) COURSE COMPLETION
Instructor signature only indicates consultation. It does not Based on attendance/participation
indicate or recommend approval or disapproval. to be notated by the instructor
yes no
yes no
yes no
yes no
Reason for drop
Student Signature
Approve Deny Deferred
Dean/Director, Enrollment Services Date
Comments:
Last date to drop Documentation attached Yes No
Posted to Record by: Date
ES778
08/31/18 White - Student File Student—Yellow
TO BE COMPLETED BY THE STUDENT
Name:
Street:
City:
State/Zip:
Petition For Excused Withdrawal
San Jacinto Campus
1499 N. State Street
San Jacinto, CA 92583
Phone: (951) 487-3215
Fax: (951) 654-6738
Menifee Valley Campus
28237 La Piedra Rd.
Menifee, CA 92584
Phone: (951) 639-5215
Fax: (951) 672-6548
Temecula Education Complex
27447 Enterprise Circle West
Temecula, CA 92590
Phone:(951) 506-6752
Fax: (951) 693-5309
San Gorgonio Pass Campus
3144 W. Westward Ave.
Banning, CA 92220
Phone:(951) 922-1327
Fax: (951) 922-1408
click to sign
signature
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click to sign
signature
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