Pass / No Pass Option Form
To use this form, you need to be currently enrolled in credit classes
Please print clearly, using blue or black ink):
AHC Student ID Number
Student’s Last Name Student’s First Name
CRN (ie 12345) Course Title & Name (ie DANC 120, Ballet) Name of Instructor: (ie Smith)
tudent’s Complete Telephone Number: ________________________________________
Student’s Complete Email Address: ________________________________________
Student’s Signature (mandatory): _______________________________________ Date: __________________
My signature verifies that I have read the instructions and have adhered to the published deadlines to select this option. I agree to
ign and return this form to the Admissions and Records office by the Pass/No Pass deadline (each course has a specific
deadline please verify the deadline via the class search function within the online credit schedule). If mailing the form, it must be
received by the deadline.
This box for Admissions & Records use only: Semester/Year: _____________
Received by: _________ Date received: ___________ Date entered: __________ Entered by: __________
Instructions for selecting the Pass / No Pass Option:
s the student it is your responsibility to:
1. P
ick up the form from the Admissions & Records office, or download it from
, complete, and sign it;
2. Li
st the correct CRN, course name and number (ie 12345 DANC 120, Ballet);
3. R
eturn the completed form by the deadline posted within the online credit schedule of classes.
By submitting this form, I understand the Pass / No Pass option policy and I elect to receive a P or NP grade in the course that I have
identified on this form. I understand that it is my responsibility to verify whether or not the course is offered with the Pass / No Pass by
checking the current college catalog or conferring with an AHC counselor. I also understand that it is my responsibility to verify if the
Pass / No Pass option is available within my major degree work or if it is transferable to a four-year college or university.
I also understand that the Pass / No Pass option is not reversible for any reason and after submitting this form to the Admissions &
Records office I may not change my mind at a later date and request a letter grade.
If you are unable to submit this form in person, you may mail it to:
Allan Hancock College
Admissions and Records Office / Request for P/NP Option
800 South College Drive
Santa Maria CA 93454-6399