S:\ARO\ARO Forms\Forms with new logo\Petition for Academic Renewal.doc
PLEASE LIST THE TERM(S) YOU WISH TO HAVE DISREGARDED AND LIST ALL COURSE WORK
WITHIN THE TERM(S).
College: __________________________________________________________ Term: _________________
Courses: __________________________________________ Units: _________________
__________________________________________ Units: _________________
__________________________________________ Units: _________________
__________________________________________ Units: _________________
__________________________________________ Units: _________________
College: _______________________________________________ Term: _________________
Courses: __________________________________________ Units: _________________
__________________________________________ Units: _________________
__________________________________________ Units: _________________
__________________________________________ Units: _________________
__________________________________________ Units: _________________
I FURTHER UNDERSTAND AND AGREE TO THE FOLLOWING:
1) That my permanent academic record shall be annotated so that it is readily evident to all users of the
records that units disregarded may not apply to certificate, degree, or general education certification
requirements.
2) That all course work remains legible on my permanent record, ensuring a true and complete academic
history.
Petitioner’s Signature: ______________________________________ Date: __________________
FOR OFFICE USE ONLY:
Petition Approved: _________________ Petition Denied: _________________
Comments: ________________________________________________________________________________________________
Dean of Instruction Signature: ___________________________________________ Date: ______________________
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