Petition for Extenuating Circumstances
Name: _____________________________________________________________________
Student ID #: 900-___ ___-___ ___ ___ ___
Last First MI
Address: ___________________________________________________________________ Phone #:( ______)_______________________
Street City Zip
AVC Email_________________________________________________@avc.edu
Exception Request Please Read Before Submitting Request
Consideration of exceptions to policies may be considered when extenuating circumstances beyond the control of the student prevented adherence to the
published regulations. Not being aware of deadlines is not an acceptable reason for seeking an exception. Relevant documentation must be submitted with
the petition. 34 C.F.R. 106.4 Students shall not be treated differently on the basis of parental, family, marital status or pregnancy and related conditions.
Substandard grade in a repeatable course Military or Excused Withdrawal ______________________
Drop with or without W Add Authorization Codes (AAC): _________________
Beyond maximum allowable repeats Other Reason_________________________________
Course Taken (if applicable)
Subject
Example: English
Course Number
101
Semester
Fall
Year
2004
Grade
F
FUTURE Course (if applicable)
Subject
Example: English
Course Number
101
Semester
Fall
Please describe your request for exception to college policy and attach an additional page if necessary.
Relevant documentation
must be submitted with petition. THIS FORM MUST BE RETURNED T0 REGISTRATION@AVC.EDU
Signature of Student:________________________________________ Date:____________
By checking this box, you acknowledge that you will use your AVC email to submit the petition and the petition decision
will be emailed to your AVC email account.
Instructor / Division Dean Recommendation and Comments
Recommend Approval:
Yes No
___________________________________ ______________________ ____________
Signature - Instructor / Division Dean Phone Date
Office Use Only Approved
Yes
No
Course:
Term:
____________________________________________
Signature – Dean, Enrollment Services Date
04/09/20
Admissions & Records
3041 W. Avenue K,
Lancaster, CA 93536-5426
Phone: 661-722
-6300 ext. 6504
Student Contact Information
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