Petition for Prerequisite Clearance Date: ____________
Counseling Department -- Bldg. 1600, Rm. 1616 -- 925-424-1400 -- 3000 Campus Hill Drive, Livermore, CA 94551
Updated: 02/28/2018
W#
Telephone/Cell Email
LPC’s
Pre-requisite
Course Completed Completed at: Units Term/Date
Score/Test
Denied
(Counselor use
Date
Entered into SEADETL for Assessment
Component completion (if applicable)
Requested LPC
Course
• Fax: Please submit this form with documentation including the header:
"ATTN: Counseling Department" to 925-424-1402
• Clearance will occur no later than 72 hours (Mon-Thurs) after
receipt of all documentation
• The front desk staff will notify student of the decision
Counseling Faculty Signature
Name (Last, First)
__________________________
How to clear a Prerequisite:
Approved Documentation
to clear a prerequisite
(please attach):
An Official or unofficial accredited college/university transcript (showing a
final grade of C or better)
• In-progress courses will not meet the prerequisite requirement.
• Private/out-of-state institutions - submit catalog course descriptions,
course outline of record, or course syllabus for equivalent coursework
AP Score report form the College Board (official or unofficial)
Assessment results from another accredited college that clearly shows
A Level 4 on the CAASPP assessment in mathematics or English language
arts/literacy (LPC does not accept a “conditional” score).
• In-person: please submit this form with documentation to the Counseling
Department, Building 1600, Room 1616
Students should submit this form with documentation (see below) if they have
completed the prerequisite(s) at another institution or via AP Scores.
click to sign
signature
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