Date Stamp and Initial
Cashier’s Stamp Document
Processing fees received:
1-Submit a statement explaining what you are petitioning and why you are petitioning for an exception.
2-Submit all appropriate documentation. Petitions without documentation will not be reviewed.
3-Consult with the Instructor/Advisor, Department Chair, and Dean by obtaining signatures and comments.
4-Ensure you have no current holds on your record that will impact the petition process.
5-Pay the appropriate processing fee to the Cashier’s Office then submit the complete packet to Admissions and
Records, WH-C290.
Student ID Number: _______________________________________________________
Name: ___________________________________________________________________
Address: _________________________________________________________________
City: ___________________________ State: ______________ Zip Code: ______________
If not a current student, please note e-mail address: ____________________________
Major___________________________________ Phone:_________________________
Applied for Graduation: No □ Yes □ Semester: ____________________________
Request Type: Change of Grade □ General Education □
Release from Fee Obligation/Refund □ Late Add
Late Withdrawal or Drop Medical Withdrawal □
Other □ Please Specify: _____________________________________________________
If request concerns a course, complete the following:
Department: ______________ Course Number: ___________ Section: ______________
Semester/Term: ______________________ Instructor: ___________________________
Student’s Signature Date
Decision: Registrar’s Office/SAPAC/Provost use only
_______Approved ______Denied _______Incomplete/Further Action
Signature: ______________________________________ Date: ____________________
Comments/Action(s) Taken: _________________________________________________
Decision: FAC use only
___Approved ___Partial Approval (Pro-Rated) ___Denied ___Incomplete/Further Action
Signature: ______________________________________ Date: ____________________
Comments/Action(s) Taken: _________________________________________________
Instructor/Advisor Comments
Support _____ Not Support ______
Signature: ____________________
Date: ________________________
Department Chair Comments
Support _____ Not Support ______
Signature: ____________________
Date: ________________________
Dean/Associate Dean Comments
Support _____ Not Support ______
Signature: ____________________
Date: ________________________
Revised: March 23, 2020
Please email the completed form with required signatures to by the appropriate deadline
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Petitions for Exceptions are not granted automatically and must be accompanied by compelling external verification/documentation
or the petition will be denied.
Steps for submitting a Petition for Exception are as follows:
1. Meet with the designated staff person or the Associate Dean from the College associated with your request to assist you in
determining whether a Petition for Exception is the appropriate procedure to address your particular situation, and if not,
other options that may be available.
2. Attach an explanation on a separate sheet, and also attach external verification/documentation (i.e. dated hospital
records, a dated physician’s letter on his/her letterhead, police records, a death certificate, dated letters from employers
on letter head, etc.). Original documentation is more credible than photocopies and will be returned upon request.
3. All appeals must use the “Petition for Exception” form. Appeals must be submitted with additional documentation. The
attached documentation must support the student’s appeal; additional documentation will not be accepted once this
petition is filed. It is imperative that the student provide all the necessary information to support the student’s petition
prior to submitting the actual petition. Once filed, additional information cannot be added to the petition due to the review
process needed and the need to be timely in that review.
4. There is a $10.00 document processing fee to file this petition which must be paid prior to submission. Attach proof of
payment for the petition fee.
5. Petitions will only be accepted for review with the appropriate signatures included.
6. Petitions will be reviewed within one week of receipt and a determination is made if further review is required by another
office, the Student Academic Petitions and Appeal Committee or the Fee Appeal Committee.
a. The SAPAC meets on a monthly basis during the Fall and Spring terms; the FAC will meet within one week following
the SAPAC meeting.
b. The student will be notified of the respective committee decision(s) within two weeks of those meetings.
7. All petition decisions will be sent via the student CSUDH e-mail account or through air mail. If not a current student, the
decision will be sent to the e-mail address provided on the petition form. It is the student’s responsibility to provide the
University with a current e-mail / mailing address at all times
Decisions of the Student Academic Petitions and Appeal Committee (SAPAC) are guided by the following principles:
Adherence to the policies and procedures in the “University Catalog” or “Class Schedule”.
“Computer Error” (i.e. TOROS, Toro Web, etc.) is only accepted with documented evidence.
Partial retroactive withdrawal needs external documentation as to why some classes were affected. (Undergraduates can
use the “Repeat and Cancel” policy).
Retroactive adds are rarely approved, even if the student attended class, completed all assignments, and received grades.
Deleting a “W” (withdrawal) or class cannot be considered as the university cannot delete record of enrollment. Medical
withdrawals do not count toward the withdrawal limit.
Refund of fees for courses the student dropped after the published deadline, did not attend, or stopped attending must be
supported with external documentation and will be referred to the Fee Appeal Committee (FAC).
Decisions of the Fee Appeal Committee (FAC) are guided by the following principles:
Any decision made by the Student Academic Petitions and Appeals Committee (SAPAC) is based on their review of grade
changes and does not have any bearing on tuition and fees.
Title V of the State Education Code restricts the credit of tuition and mandatory fees to the deadlines as published in the
Schedule of Classes.
It is the student’s responsibility to follow the published procedures for class cancellations, drops and deadline dates.
The student must drop or withdraw from affected classes prior to submitting this appeal.
If the SAPAC has approved action that results in changes that MAY affect fees, the petition will be referred for further
action regarding fees.
An adjustment in student’s tuition may also result in an adjustment to the student’s financial aid award.
The decision of the Fee Appeal Committee is final.