Fillable STUDENTPETITIONFORM ADMISSIONSANDRECORDSOFFICE PURPOSEOFTHESCCSTUDENTPETITION TheStudentPetitionprovidesstudentswithanopportunitytorequestactionthatisnormallynotpermittedbystatelaw,district policy or

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STUDENTPETITIONFORM ADMISSIONSANDRECORDSOFFICE PURPOSEOFTHESCCSTUDENTPETITION TheStudentPetitionprovidesstudentswithanopportunitytorequestactionthatisnormallynotpermittedbystatelaw,district policy or college practices (Sacramento City College)

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STUDENTPETITIONFORM

ADMISSIONSANDRECORDSOFFICE



PURPOSEOFTHESCCSTUDENTPETITION

TheStudentPetitionprovidesstudentswithanopportunitytorequestactionthatisnormallynotpermittedbystatelaw,district

policy or college practices and procedures. The Student Petition is limited in scope to issues related to a student’s admission,

enrollment,andacademicstanding.SeetheSCCCatalogforpoliciesrelated

toyourrequest.



Pleasecompletethefollowing.PRINTlegiblyandclearly.



StudentName:____________________________________________StudentID:__________________________

Address:____________________________________Apt:_________Phone:()______________________

City:___________________________State:______Zip:__________Email:______________________________



1.ACTIONREQUESTED

Pleaseindicatetheactionrequestedbycheckingthe appropriatebox.Refertoinstructionsonreversesideformoreinformation.



UnauthorizedCourseRepeat Drop OtherRequest 

Repeataclasscompletedwithapassinggrade NeverAttended LeaveofAbsence–(RetainCatalogRights)

Repeataclassattempted3ormoretimes ExcusedWithdrawal Other(PleaseSpecify):





2.COURSESAFFECTED

Semester Year CourseNameandNumber(i.e.ENGWR300)

FallSpringSummer 



3.STUDENTSTATEMENTPleaseprovideawrittenexplanationandattachsupportingdocuments.(Requiredforallrequests)



4.STUDENTSIGNATURE:_____________ _______________________ ______________ DATE:________________________



ADMISSIONSUSEONLY



YourPetitionhasbeenreviewedandyourrequesthasbeen:



ApprovedDeniedReturned



Comments:_______________________________________________________________

_________________________________________________________________________



ReviewCommittee:______________________________Date:___________________

StaffInitials/DateStamp:

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

STUDENTPETITIONFORM

INSTRUCTIONS



USEOFTHESTUDENTPETITIONFORM

TheStudentPetitionFormisusedtorequestthefollowingactions:



1. ApprovalofanUnauthorizedCourseRepeat

Usethisformtorequesttherepeatofacourseinwhichyou:a)havealreadyearnedagradeofCorbetter;

orb)haveattemptedacourse3timesinwhichaWorgradesofD,F,orNC/NPhavebeen

earned.

Exception:CoursesidentifiedintheSCCCatalogasapprovedformultipleenrollments.Thisformisnot

requiredforthosecourses.



Acceptablereasonstorepeataclassyou’vealreadypassed:

 RecencyRequirement:theprogram,class,orcollegeyouinwhichyouwillbeenrollingrequiresa

coursetobe

takenwithinacertaintimeframe.Forexample:CSUSrequiresitsBusiness

Administrationstudentstohavetakencertainaccountingclasseswithinthelastsevenyears.Ifyou

tookaccountingeightyearsago,thatpetitioncouldbeapproved.Youwillneedtoattach

documentationoftheRecencyRequirement.

 ExtenuatingCircumstance:

ifyourmostrecentpreviousgradeis,atleast inpart,theresultofa

verifiedcaseofaccident,illness,orothercircumstancebeyondyourcontrol.Youmustattach

documentation.

AcceptableReasonstorepeataclassyou’veattemptedthreetimes:

 ExtenuatingCircumstance:ifyourmostrecentpreviousgradeis,at

leastinpart,theresultofa

verifiedcaseofaccident,illness,orothercircumstancebeyondyourcontrol.Youmustattach

documentation



2. Drops

Usethisformtodropclassesduetothefollowingcircumstances:

 Dropaclassthatwasneverattendedinwhicha WorgradesofD,F,orNC/NPhasbeenassigned.

o Thisinformationwillbeverifiedbytheinstructorofrecord.Iftheinstructorisno

longer

available,noactionwillbetaken.

 WithdrawfromaclassafterthelastdaytodropwithaWhaspassed,ExcusedWithdrawal,

beginningforclassesinfall2018andlater.

o Thisisonlyconsideredincasesofextenuatingcircumstances(verifiedaccident,illness,or

othercircumstancebeyond

yourcontrol)anddocumentationmustbeprovided.

o Theinstructorofrecordwillbeconsultedforapproval.Iftheinstructordoesnotapprove

orisnolongeravailable,noactionwillbetaken.

3. LeaveofAbsence

UsethisformtoapplyforaLeaveofAbsencewhichwillretainyour

catalogrightsforuptotwocalendar

years.Leavescanbeapprovedforeither:

 Medical(provideastatementfromyourmedicalproviderexplainingthenecessitytointerrupt

enrollment).Currentnotationswillnotberemovedfromyourrecord.

 Military(provideacopyofmilitaryordersinductingservice).Currentnotation

willbechangeto

MW(MilitaryWithdrawal).



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