ACADEMIC AMNESTY FORM
Signature:
Date:
First Name Middle Name Last Name
Street City State Zip
Student ID # Cell Phone # Email Address
Semester(s) Requested for Acdemic Amnesty:
Academic Year(s): Term(s) (Fall, Winter, Spring, Summer):
I understand that all of the courses taken during the period for which amnesty is granted will remain on my
academic record. However, these courses are eliminated from computation of the grade point average and
will not be applied to a Certificate or Degree program at Quincy College.
Registrar’s Signature Date
Academic Vice President’s Signature Date
Plymouth, Quincy & Online
www.quincycollege.edu
Quincy College
Quincy Campus | 1250 Hancock Street, Quincy, MA 02169
Plymouth Campus | 36 Cordage Park Circle, Plymouth, MA 02360
Approved: Denied:
Please explain how you will perform better academically going forward.
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