Revised Oct 2014
PETITION FOR LATE REGISTRATION
Pierce College must follow State guidelines related to course enrollment. In compliance with these guidelines, we must document the
reason a student adds classes after the published registration deadlines. See quarterly eSchedule for registration dates.
Instructions to Student:
Ensure all three sections below are completed.
Submit completed petition and a registration or schedule change form to the Registration Office.
Tuition and fees:
If petition is approved, a non-refundable late registration fee of $40.00 per class will be charged.
Tuition and fees must be paid within 1 business day if your petition is approved.
Submission of this form does not guarantee that the petition will be approved. You will be notified of the decision within five
business days. Incomplete petitions will be denied.
1. STUDENT
Name: ________________________________ Student Identification Number: ___ ___ ___ / ___ ___ / ___ ___ ___ ___
Quarter/Year: ____________ Class Item #: ____________ Course Department & #: _________________________________
Explain the reason, in detail, for your late registration and describe why this exception should be approved. Continue on reverse if
additional space is needed.
Student Signature:___________________________________________________ Date: ___________________________
2. INSTRUCTOR
I request that the above named student be considered for late enrollment. There will be minimal impact to others in the class.
FIRST DAY STUDENT ATTENDED (DO NOT LEAVE BLANK): ________________
Please provide justification for enrollment beyond the normal registration timeline:
Instructor Signature: _________________________________________________ Date: ___________________________
Please discuss this form with your Division Dean, prior to signing if you have questions or concerns.
3. DIVISION DEAN ______Approved ______Denied
Comments:
Division Dean Signature: _____________________________________________ Date: ___________________________
FOR REGISTRATION USE ONLY: ______
______
Back Date
Y
N
SM4015
Qtrly Late List _________
Fee _________
Payment _________
Registrar Signature:
_________________________________________________
Date:
___________________________
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