THIRD ATTEMPT FORM
PLEASE PRINT CLEARLY IN BLUE OR BLACK INK:
_____________________________________________________________________________________________
Student’s Last Name Student’s First Name MI Student ID #
_____________________________________________________________________________________________
Course (s) Requested Term
Previous terms course taken: ______________________ _______________________
Term Term
By signing below, I acknowledge all the following:
I received a “D”, “F”,” W”, "NC", or “NP” in my previous 2 attempts of this course and am
requesting to take this course a 3
rd
time.
I understand this is my final attempt and I will not be able to take the class again within Yuba
Community College District (All Campuses).
I understand it is recommended that I access resources to ensure that I am successful in my final
attempt; such as tutoring, counseling, meeting with professor during assigned office hours, and
studying at least two hours for every one hour of class.
Comments:___________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
After meeting with a counselor, the student must submit this completed form and add slip to Admissions and
Records at time of enrollment.
____________________________ __ __/__ __/__ __ ____________________________ __ __/__ __/__ __
Student’s Signature Date Counselor’s Signature Date
Admissions and Records Office Use Only:
Processed by: ___________________________________________ Date: __ __/__ __/__ __
