Please complete the requested information completely. Applications that are incomplete cannot be
processed. Return completed applications to the Records Office in the Administration Building. I you
have any questions concerning your educational plan and/or your academic progress toward the
Associates Degree or Certificate, please make an appointment with the Counseling Office (909-384-4404)
BEFORE submitting this form.
Petition submitted for year 20___
Fall (Deadline Oct. 1st)
Spring (Deadline March 1st)
Summer (Deadline July 1st)
When this deadline falls on a Saturday or a Sunday, the ling period will be extended to the following Monday.
Degree and/or Certicate sought (You must le a separate petition for each degree and/or Certicate sought):
r Associate in Arts Degree Major ___________________________
r Associate in Science Degree Major ___________________________
r Certicate of Achievement Major ___________________________
Student Information - Please PRINT
Please answer YES or NO to the following:
NAME __________________________________________________ STUDENT ID# __________________
NUMBER-STREET CITY STATE ZIP
PRIMARY TELEPHONE ___________________ ALTERNATE TELEPHONE _____________________
OTHER NAMES USED AT SBVC ______________________ DATE OF BIRTH ____________________
STUDENT EMAIL _______________________________________________________________________
_____ If you are applying for a degree, do you have a graduation check? If yes, attach a copy. If no, please make an
appointment with a counselor before submitting this application.
_____ Have you attended SBVC prior to 1981? If so, when? ___________________________
_____ Have you petitioned to have courses waived or to substitute a course? If yes, attach documentation.
YOUR PETITION CANNOT BE PROCESSED UNLESS ALL DOCUMENTATION IS ATTACHED
u Response to this petition will be sent to your SBVC email account t