Fillable Name of Student Student ID Number (Danville Area Community College)

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Name of Student Student ID Number (Danville Area Community College)

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Grade Exclusion Request
Revised 1/2021
I request that ,
Name of Student Student ID Number
grade exclusion be awarded for Semester Year
Semester Year
Semester Year
Student is presently enrolled: Yes No
Comments:
Academic Advisor/Division Dean Date
Vice President for Academic Affairs Date
Note: Request can be made after a period of at least two years and evidence of noticeable
improvement.
**Student transcript must be attached to this form for approval.
White copy Yellow Copy Pink Copy Gold Copy
Vice-President’s Office Records Office Counseling Office Student copy
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Name of Student Student ID Number (Danville Area Community College)

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Completed 3 February 2021

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