SS-022
TIDEWATER COMMUNITY COLLEGE
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Academic Renewal Petition Form
Please return this completed form to Enrollment Services and the Oce of the College Registrar.
Student Name: _______________________________________________________________________________________________
Last First M.I.
Former Name(s): ___________________________________________________________________SIS ID:_____________________
Street Address: _________________________________________ City: ____________________ State: __________ Zip: __________
Telephone (Home): ___________________________(Work): _____________________________
I am or will be receiving Financial Aid: Yes ❑ No ❑ I am or will be receiving Veterans Benets: Yes ❑ No ❑
As per § 5.7.0.5 of the Virginia Community College System Policy Manual, I believe that I meet the following eligibility requirements for
"Academic Renewal" and hereby petition to have my cumulative grade point average (GPA) adjusted accordingly:
1. I have been separated from the college for (at least) 5 years from ____________________ to _____________________ and
term/year term/year
2. I have earned (at least) a 2.5 grade point average for the rst 12 (twelve) credits completed after re-enrolling from my 5-year
separation. e qualifying "2.5 GPA based upon the rst 12 (twelve) semester hours completed" is based on the entire
term(s) in which the 12 credit hours are achieved. A 2.5 GPA must be achieved based upon a calculation of all courses and
attempts within the qualifying period of re-enrollment.
3. Please indicate the Academic Renewal adjustment period that you are requesting. Note: Consecutive semesters/terms are
required. From ____________________ to ____________________
term/year term/year
I understand that in receiving an Academic Renewal adjustment to my cumulative GPA:
• an Academic Renewal adjustment may be granted only one time;
• once granted by the College, Academic Renewal cannot be revoked;
• an adjustment will be made to my cumulativeGPAbyexcludingallgradesof"D"and"F"earnedpriortothequalifyingperiod
of re-enrollment;
• although my cumulative GPA will be adjusted in future terms, all of my previously earned grades will be shown on my
permanent record (including the excluded grades of "D" and "F");
• any course credit with a grade of "D" earned during the Academic Renewal adjustment period will not count toward future
graduation requirements;
• the Veterans Administration will not reimburse me for courses retaken in which I previously received a "D";
• an "Academic Renewal" notation will be made on my permanent record; and,
• the granting of Academic Renewal does not aect any previous academic, nancial, or administrative determination made by
the college.
Student's signature: ___________________________________ Date: ___________________________
ENROLLMENT SERVICES OFFICE:
❑ Student Meets Eligibility Requirements ❑ Student Doesn't Meet Eligibility Requirements
Requirement Reviewed by: _________________________________________________ Date: ________________________________
OFFICE OF THE COLLEGE REGISTRAR:
Processed by: ___________________________________________ Date: _________________________________
10/14
WC 9/22/17
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