SanDiegoCommunityCollegeDistrict
PETITIONFORMODIFICATIONOFGRADUATIONREQUIREMENTS
CityMesaMiramar
PurposeofPetition:Substitution Waiver
SelectOne:MajorRequirementDistrictRequirementDistrictGeneralEducationRequirement
Name CSID_______________________________
(PRINT)Last First Middle
Address
NumberStreetCityState Zip
Email_______________________Telephone
AssociateDegree CertificateofAchievementCertificateofPerformance‐SDCCDCoursesOnly
Major Specialization
RequiredCourse(e.g.CHEM100)CourseTitle #units
Course(s)tobeSubstituted CourseTitle #units______
Takenat(Institution)
• Attachadetailedjustificationforyourpetition
• Attachrequiredsupportingdocumentation
Transcript(s)ComputerizedEducationPlan
CatalogDescriptionofProposedSubstituteCourse(s) Otherdocumentation
Student’sSignature_____________________________________________Date________________________
OfficialUseOnly
DepartmentChair’sRecommendation
Name(PRINT)SignatureDate
Dean’sRecommendation
Name(PRINT)SignatureDate
Committee’sAction ApprovedDenied
Reason(s)
Signature Date
Evaluator’sAction Approved Denied
Reason(s)
Signature Date
White:StudentFolderYellow:FinalDecisiontoStudent SS‐PETMOD‐4/12