Learning Services Rev. 8/2019 LEN/dg
Vice President for Learning Services
Arizona Western College P.O. Box 929 Yuma, AZ 85366-0929 .
Phone: (928) 344-7519 Fax (928) 317-6022
This form can also be emailed to: instructional.petitions@azwestern.edu
PETITION FOR INSTRUCTIONAL ISSUES
Name:____________________________________________ Student ID# _________________
Phone (Mobile): _____________________ Home:________________ Other:_________________
Toro Email:_______________________________________________________________________
Mailing Address:_______________________________ City:__________ State:____ Zip:________
Semester courses taken: Fall – Spring – Summer Year: _______ Declared Major :_____________
Instructional Issues that may be considered include: (please check)
Academic Renewal (after an absence of at least one year and successful completion of twelve (12) or more credits after returning)
Faculty Concerns Change of Grade for Course ___________________
Course Substitution (catalog year) _____________
Course completed _________________ Substitution Course Requested ________________
Other ____________________________________
*Instructional Issues do not include Refund Requests. Please contact the Business Services Office regarding refund policies.
St
ate specifically the action that you are requesting and why. (Be brief but thorough. You may attach another page
if necessary. If requesting a course substitution, please list which degree you want this to be applied to.)
Student Signature:________________________________________________ Date: ___________________
Instructor’s Signature (optional): _____________________________________________________________
All information is required unless otherwise noted. Failure to provide all requested information may result in petition being delayed.
Students will receive a letter regarding the final decision via their Toro email within 15 business days of petition receipt.
DO NOT WRITE BELOW THIS LINE
------------------------------------------------------------------------------------------------------------------------------
Request is: ____Approved _____Denied _____Closed Referred to:_____________________________
Si
gnature: ______________________________________________________; Vice President, Learning Services
Da
te: _______________ Comment: _____________________________________________________________
Distribution: Registrar, Student, Vice President for Learning Services, Business Office if indicated
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
