Fillable Special Consideration Request Petition.2018 - Special Consideration Request Petition.2018

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Special Consideration Request Petition.2018 - Special Consideration Request Petition.2018

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ColumbiaCollege
SpecialConsiderationRequestPetition
ATTN:Admissions&Recodes
11600ColumbiaCollegeDrive
Sonora,CA95370(209)588‐5231
AnemailwillbesenttoyourstudentemailaccountwhentheCommitteehasmadeadecision
onyourpetition.Incompletepetitionswillbereturned.
Typeinyourresponses:
Date:__________Name:_________________________________________________________
StudentID“w”#:________________________________Phone#:________________________
StudentE‐Mail:_________________________________________________@my.yosemite.edu
StudentSignature:______________________________________________________________
Request:Whatactionorresultareyourequesting?Pleaseinclude:classname,section
number,instructorname,termandyear.
Justification:Whatdoyoufeelis
thejustificationforyourrequest?Attachsupporting
documentationi.e.physiciannotes,legalrulings,accidentreportsetc.
ClassName:________________Section#:___________Instructor:______________________Term/Year:_____________
Action:_____________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Explanation:____________________________________________________________ ______________________________
___________________________________________________________________________________________________ _
___________________________________________________________________________________________________ _
___________________________________________________________________________________________________ _
___________________________________________________________________________________________________ _
___________________________________________________________________________________________________ _
___________________________________________________________________________________________________ _
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Special Consideration Request Petition.2018 - Special Consideration Request Petition.2018

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Completed 11 March 2020

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