Fillable Prerequisite Challenge Form (Folsom Lake College)

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Prerequisite Challenge Form (Folsom Lake College)

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4/2020 (over)
Prerequisite Challenge Form
This form may be used to challenge placement results or to have a course from a college outside Los Rios
reviewed to see if it meets a prerequisite according to an approved Los Rios Community College District process
and in accordance with Title 5 [Article 2.5 section 55200-55202].
To challenge Los Rios placement results, include:
Copy of Los Rios placement results
Evidence that you have the skills required to
meet the prerequisite (See reverse*).
To have a course from a college outside of Los Rios
reviewed to meet an FLC prerequisite, you must include:
Catalog description of the course (printout)
Unofficial transcript
STEP 1: Student Information
Name: ___________________________________________________ Date: ______________________
Student ID: _______________________________________________ Phone #: ____________________
Los Rios Email: W________________ @apps.losrios.edu (Your challenge results will be sent to this email.)
STEP 2: Folsom Lake College Course Information
The course you want to enroll in at Folsom Lake College:
COURSE NAME: __________________________ PREREQUISITE: ___________________________
(Example: Math 100) (Example: Math 30)
STEP 3: Course Information (do not fill this out if you are challenging an assessment placement)
Institution where the prerequisite course was
completed.
Course Title
Grade
Received/
Year Taken
Semester or quarter units
STEP 4: Student Acknowledgement and Signature
I acknowledge that Folsom Lake College has determined this prerequisite is necessary for success in this course. I am
taking personal responsibility for succeeding without this prerequisite should my challenge be granted. I am responsible
for retaining my challenge results. I further acknowledge that I am the sole originator of all work submitted as
documentation.
_________________________________________ ______________________________________
Student Signature Date
The Prerequisite Challenge committee is composed of two
discipline experts excluding the instructor of the course.
You will be notified via email of the results of your
challenge within five business days.
click to sign
signature
click to edit
4/2020 (over)
STEP 5:Challenge Results and Processing
Approved Denied
If denied, state reason:____________________________________________________________________________
__________________________________________________________________________________________________
____________________________________ ____________________________
Faculty committee member Date
____________________________________ ____________________________
Faculty committee member Date
Student Notification (date & initial) ____________________________
*Supporting Documentation:
Each discipline has different criteria for what constitutes valid evidence of a student having the necessary skills to meet a
prerequisite.
ENGLISH
Portfolio with coursework writing samples
Portfolio of work experience (reading/ writing)
Reference letter from LRCCD English/
Reading instructor
ESL
Portfolio of work experience (reading/ writing)
Reference letter from LRCCD English/
Reading instructor
PSYCH
Students may choose to complete the
Psychology 335 Prerequisite Challenge
Supplement as one form of evidence for
meeting the Psych 330 prerequisite. The
supplement is available from the PSYC 335
instructor.
OTHER
Example of prior coursework
A letter from a LRCCD discipline-specific
faculty member
Delivery Instructions::
Completed applications should be submitted by the student to the appropriate Instructional Area Dean who oversees the
prerequisite course subject. For example, history classes have an English prerequisite. The challenge application should
be directed to the Dean over English, not history.
Math, Science, CIS, Library &
Engineering
G. McCormac / Asst. L. Santoro
FL4-128 (FLC main)
(916) 608-6700
FLC-MathPrereq@flc.losrios.edu
Visual & Performing Arts,
Language & Literature
F. Fletcher (interim) / Asst. M.
Quintell
PAC Dean suite (FLC main)
(916) 608-6621
FLC-EnglishPrereq@flc.losrios.edu
Business
Social & Behavioral Sciences
& Humanities
C. Lopez (interim)
FLC backup: G. McCormac
RCC (Rancho Cordova Center)
(916) 361-6321 lopezc@flc.losrios.edu
FL4-128 (FLC main)
Career & Tech Education
V. Maryatt / Asst. C. Mesa
FL2-144 (FLC main)
(916) 608-6927 mesac@flc.losrios.edu
Kinesiology, Health, Athletics
M. Wright / Asst. J. Croff
G-180 (FLC main)
(916) 608-6687 croffj@flc.losrios.edu
Human Career Development
(HCD)
M. Senecal / Asst. A. Kravchuk
FL1-Student Svcs. (FLC main)
(916) 608-6769
kravcha@flc.losrios.edu
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Prerequisite Challenge Form (Folsom Lake College)

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Completed 4 September 2020

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