ID #
Term/Year:
Phone:
I request:
Academic Renewal
(attach documentation to support request)
_______________________________
Non Traditional Credit: Other—
be specific_______________________________
CEEB Advanced Placement Program
Advanced Placement Program
(attach scores)
College Level Examination Program
(attach scores)
Waive course requirement for graduation or Certificate of Achievement
(Attach documentation to support request-faculty recommendation required.)
_______________________________________ _________________________________
Course to be waived Course to be substituted
Reason(s) for Request:
(attach additional sheets if necessary
)
_______________________________________________________ __________________
Student Signature Date
OFFICE USE ONLY
Staff Recommendation:
Comments:
___________________________________________ __________
Signature Date
Decision:
Comments:
______________________________________________ ________________________
Signature Date
San Jacinto Campus
1499 N. State Street
San Jacinto, CA 92583
(951) 487-3215
Menifee Valley Campus
28237 La Piedra Rd.
Menifee, CA 92584
(951) 639-5215
Temecula Education Complex
27447 Enterprise Circle West
Temecula, CA 92590
(951) 506-6752
San Gorgonio Pass Campus
3144 W. Westward Ave.
Banning, CA 92220
(951) 922-1327
Approved Denied Deferred
ES 686 08/17 White Copy – Student Folder Yellow Copy – Student Pink Copy – file copy sent to Instruction
Name:
Street:
City:
State/Zip:
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