U
se this petition to request to repeat a course under specific circumstances as noted below. Documentation is required for all
requests, and is explained below each type of circumstance. Failure to provide all required documentation will result in the peti-
tion being denied. You will be notified of the outcome via the email you indicate on this form.
EXTENUATING CIRCUMSTANCES: are verifiable cases of accident, illness or other circumstances beyond the control of the
student. Acceptable forms of documentation include doctor’s notes; proof of hospitalization or acting as a relative’s caregiver;
police reports of accident, etc. Documentation must show that circumstances interfered with a student’s ability to
successfully complete the class or drop it by the deadline.
________________________________________________________________ _______________________________
NAME LANCER ID #
____________________________________________________________________________ __________________
ADDRESS CITY STATE ZIP DATE OF BIRTH
_________________ ________________________ _______________________________________
COURSE ID TERM/YEAR EMAIL
_______________________________________
PHONE NUMBER
INSTRUCTIONS
• Check only one box per petition and one class per petition
• Attach the required documentation (See details below)
• Attach your personal statement as required (See below for details)
I AM PETITIONING TO REPEAT A CLASS DUE TO THE FOLLOWING CIRCUMSTANCES:
___ I need to repeat a course for a 4
th
attempt (already taken 3 times) in order to get a passing grade. Provide all of the
following:
• Personal statement explaining what prevented you from passing or dropping the class in the past, and what has
changed that will enable you to pass the class if allowed to take it a 4
th
time.
• Documentation of verifiable extenuating circumstances to support your statement.
• You may not repeat a class you have already passed with a grade of C/P or better under this option
___ I need to repeat a class because the curriculum/software or industry standards have changed and I need to update my
skills in order to get/keep a job. Provide all of the following:
• Written confirmation from instructor or other source that the curriculum/software has changed
• Written proof that industry standards have changed (example: new licensing requirements)
• Written confirmation from your employer/prospective employer that you are required to update your
skills/knowledge by repeating this course
___ I am legally required to repeat this course in order to keep my paid or volunteer job. Provide all of the following:
• Proof that the course is required by regulation or statute as a condition of employment
• Proof that you are employed or seeking employment in a job that requires this course
___ I need to repeat a course I passed with a grade of C or better, at least 3 years ago. Provide all of the following:
• Proof that the course is required as a “recency” prerequisite by either PCC or another college to which you plan to
transfer.
___ Other (Typed explanation required, documentation of circumstances may be required)
________________________________________________________
Student Signature Today’s Date
OFFICE USE ONLY
_____ Approved _____ Denied
Reason for denial: __________________________________________________________________________________
___________ ____________ ____________ ____________ ________________ _____________
Approved By Date Recorded By Date Response By Date
PASADENA CITY COLLEGE
PETITION TO REPEAT A COURSE
ADM386 1/16
