San Bernardino Valley College
Petition for Readmission
Instructions -
See a counselor for an Education Goal Plan and attach a copy to this petition
Write an essay (150-200 words) stating your plans to improve your academic performance (print in space
below, or attach a word-processed document)
Submit to the Office of Admissions & Records
Student Name
Street Address
City/State/ZIP
Student ID #
Birth Date
Telephone #
Are you a client of any of these programs?
DSP&S STAR CalWorks EOPS/Care FA SP SU ____YR
Counselor Signature ________________________ Student Signature ___________________________ Date___________
Office Use Only
Approved Denied Tabled Other
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Director, Admissions & Records Date________________________
Semester & Year you wish to return
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