PETITION FOR ACADEMIC RENEWAL
LOS ANGELES HARBOR COLLEGE
Name: _________________________________________ Student ID #: ________________________
Last First
Address: ____________________________________________________________________________
Phone Number: _______________________________
BEFORE SUBMITTING THIS FORM TO THE ADMISSIONS OFFICE, PLEASE SEE A COUNSELOR TO CHECK THAT
YOU ARE ELIGIBLE FOR ACADEMIC RENEWAL.
List of classes that you are requesting academic renewal:
COURSE NAME AND NUMBER SEMESTER TAKEN SECTION # GRADE
1. ________________________________ _____________________ ___________ _______
2. ________________________________ _____________________ ___________ _______
3. ________________________________ _____________________ ___________ _______
4. ________________________________ _____________________ ___________ _______
5. ________________________________ _____________________ ___________ _______
__________________________________________ ______________________________
Student’s Signature Date
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DO NOT WRITE BELOW THIS LINE---------------------------------------------
Academic Renewal Approved Denied
____________________________________ _______________________
A & R Official Signature Date
Official transcript must be mailed directly to the Admissions Office from the college or university to
process the academic renewal.
Comments: __________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Processed on: ______________________ Student Notified on: _________________ By: __________
