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Reduce Course Load (RCL) Authorization Form
MEDICAL REASON
The informaon requested on this form is needed to comply with U.S Cizenship and Immigraon Service reglaons.
The internaonal student named below is applyi_______ng f or approval to take a reduced course load (less than 12 units.)
Permission from the ISC must be obtained bef_____ore the student registers for less than full me and/or drops below 12 units.
This form is for those who are eligible for a reduced course load due to medical reasons. To determine
your eligibility, complete this form and att
ach an original letter on business letterhead from a licensed
doctor stang diagnosis, treatment, and the recommended amoun
___________________________________________________________
t of units to be taken per semester.
Once complete, schedule an appointment with an ISC Advisor in D-204 to discuss your eligibility further.
Student to c_________________ omplete:
Name: ________________________________ _________________________________ ______
Date of Birth: __________________
Family Name First Name MI mm/dd/yyyy
Address: _______________________________________ _______ _______________________________________ ______________
Street Apt# City & State Postal Code
E-mail:__________________________________@go.pasadena.edu
Cellphone #: __________________________________________
__________________
C ID#:_______________________ SEVIS ID#: N00_________________________
PC
Requested for Semester: ___________________ # of Units: _____________Expected Graduation Date: ____
__
I state that the information I am providing on this form is true. I further understand that it is a violation of U.S. law to give false
information to the college.
Student Signature Date mm/dd/yyyy
ISC Advisor to complete:
The following information must be completed by the ISC.
Letter from Physician
Yes No
Illness or medical condition requiring RCL for one semester.
Illness or medical condition requiring RCL for 2
nd
semester.
Illness or medical condition requiring 0 credits for one semester.
As the ISC advisor, I authorize the student named above to carry less than the required number of units.
Request log
Email student
Email A&R
Unit # _____ SEVIS SARS
Important Note: All paperwork requests require 10 business days to process. revised 4/25/2018
