KCCD/AW 07/13/2016 1 | Page
SELECT TYPE OF DISMISSAL: ACADEMIC DISMISSAL PROGRESS DISMISSAL ACADEMIC & PROGRESS DISMISSAL
NAME: ___________________________________________________STUDENT ID: @____________________
ADDRESS: _____________________________ CITY: ___________________ STATE: ______ ZIP: __________
CONTACT PHONE: _____________________ BC EMAIL: ______________________@email.bakersfieldcollege.edu
Required Steps and Documentation (INCOMPLETE PETITIONS WILL NOT BE ACCEPTED)
Step 1
a. Provide a specific explanation of what happened that caused academic failure leading to dismissal.
b. State the reason(s) for substandard grades and/or frequent withdrawals.
c. Provide a brief description outlining what changes have taken place and/or what strategies and academic
resources will be utilized to help get back into good academic standing.
Step 2- If there are extenuating circumstances, please include appropriate documentation.
(Doctor’s note, police report, etc.)
Step 3- Submit all documents to
Probation/Early Alert Program Manager, Dr. Michael McClenic
in the BC Counseling Center.
Your petition will be reviewed and you will be notified of your status by email and/or phone within 15 calendar
days after the application has been received.
_____________________________________ _______________________________
Student Signature Date
Notes
CUMULATIVE GPA:
ATTEMPTED UNITS:
COMPLETED UNITS:
STUDENT NOTIFIED: _________________
Program Manager: Approved Denied
DATE
Signature _______________________ Date: ____________
Approved Denied
Counselor Printed Name
_________________________
Counselor Signature Date
OFFICE USE ONLY
click to sign
signature
click to edit
click to sign
signature
click to edit
KCCD/AW 07/13/2016 2 | Page
Please state the reason(s) for substandard grades (D, F) and attach, if appropriate, any proof for the
frequent withdrawals and/or incompletes (W, I):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please explain what measures you have or will make to improve your academic performance:
(Attach separate sheet, if needed)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________