Fillable Petition To Withdraw (Los Angeles Valley College)

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Petition To Withdraw (Los Angeles Valley College)

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The Petition To Withdraw (Los Angeles Valley College) form is 2 pages long and contains:

1 signature
9 check-boxes
62 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Los Angeles Valley College

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Withdrawal Petition

Effective: 02/06/2012

APPROVED

DENIED

NO ACTION

ACTION POSTPONED

__ __ / __ __ / __ __ __ __

Date

No serious compelling reason

Note: _______________________

Note: ____ ___________________

No documentation for claim

____________________________

_____________________________

Print Name & Title

Signature/ Date

Withdrawal from class after the state-mandated drop deadline published in the Schedule of Classes will only be approved in “verified cases of

accidents, illness, or other circumstances beyond the control of the student, such as death of an immediate family member, natural disaster,

and/or other reasonable obstacles that prevented a student from complying with college procedures for dropping a class.” (E-69) You must

provide documentation. If this petition is granted, it may affect your financial aid & it may not be undone. By submitting this petition, you

understand that if it is granted, you may need to re-pay the money you were awarded by financial aid for the time period of this petition.

You will be notified in writing within 6-8 weeks. The decision is final. You must:

1. Submit a completed Petition to Withdraw From Class(es)

2. Attach a type-written statement explaining reasons for the withdrawal request (with your name & student ID on the upper right

hand corner).

3. Attach documentation verifying the reasons for your request.

________________________________________________

First Name MI

_____ _____ _____ _____ ____ _____ _____ _____

Date of Birth

________________________________________________

City State Zip Code

________________________________________________

LACCD Email Address

YOU MUST Fill OUT ALL THE FOLLOWING INFORMATION

I am petitioning to withdraw from class(es):

□ Winter

1. I took these classes during the:

2. I would like the withdrawal(s) recorded on my transcript:

3. and I would like:

□ Fall

□ With a “W”

□ Fees Waived

Section #

Course Title and Description

Section #

Course Title and Description

Student Signature

Date

Student Name (Please Print)

PETITION TO WITHDRAW FROM CLASS (ES)

_________________________________________________________

Last Name

____________________________________________________

Student Identification Number

_________________________________________________________

Street Address

_________________________________________________________

Telephone Number

□ Spring

□ Without a “W”

□ A refund of fees

□ Summer

20 __ __

□ With an “EW”

(An EW does not

waive or refund

fees)

click to sign

signature

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Withdrawal Petition

Effective: 02/06/2012

Statement …

____________________________________________________________________________________________________________

Fillable Petition To Withdraw (Los Angeles Valley College)

Fill Online, Printable, Fillable, Blank Petition To Withdraw (Los Angeles Valley College) Form

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