Fillable ffE Fresno City PETITION TO WITHDRAW UNDER EXTENUATING (Fresno City College)

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ffE Fresno City PETITION TO WITHDRAW UNDER EXTENUATING (Fresno City College)

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ffE
Fresno
City
:
PETITION TO WITHDRAW UNDER
EXTENUATING CIRCUMSTANCES
NAME
:
ADDRESS:
:
CITY, STATE, ZIP:
STUDENT ID
PHONE
EMAIL:
Instructions:
IMPORTANT
Petitions submitted without appropriate documentation will be denied and returned to you without review.
A. If withdrawing for Medical or Mental Health reasons, submit this petition directly to the Admissions and Records
Counter at ST-109, with a letter from the Treating Medical or Mental Health Professional confirming that a medical
or mental health condition requires you to withdraw.
B. If withdrawing for any other reason, submit this petition to the Admissions and Records Counter at ST-109. Reliable
Third Party documentation verifying your extenuating circumstances MUST be submitted with this petition.
Section I – List all courses from which you wish to withdraw based on extenuating circumstances:
1. Please read the attached instruction sheet carefully. Before Petitioning, you should also consult with your instructor(s)
regarding your withdrawal from the class(es).
2. In Section I below, list the classes to be considered by this petition. If you are not dropping all of the classes for the
semester, you must explain why in an attached letter, or your petition will be denied.
3. The deadline to petition to withdraw from a class is the end of the next regular semester (Spring or Fall).
Semester
Course
Section #
Instructor Name
Office
Use Only
Approved
Dis-
approved
Student must ATTACH a clear and concise statement along with supporting documents when submitting petition.
STUDENT SIGNATURE DATE
Section II – FOR OFFICE USE ONLY: A&R Received Date A&R Received By
ENROLLED PARTIAL WITHDRAWAL 3
rd
PARTY DOC MEDICAL DOC
Admissions & Records Comments BY
Approved Disapproved
Academic Standards Committee Designee Date
Symbol Assigned EW
MW Processed By Date
Co
py to Student Date
•
•
•
•
PETITION TO WITHDRAW UNDER EXTENUATING CIRCUMSTANCES
Copy
of Death Certificate and proof of relationship documentation needed
Copy of Court summons of Jury
Duty required.
3. Medical/Psychological
5. Military Service
1. Death in the immediate family
2. Jury Duty
4. Work Schedule Changes
A letter verifying medical or mental health need from a treating medical or mental health professional,
indicating the dates and semester affected, must be presented to the Admissions and Records Department
with a Release of Medical Information.
A letter from Employer, on
Company letterhead, indicating the dates and hours of work schedule changes
requested by the company.
Copy of Military Orders is required.
I. INSTRUCTIONS:
1. Petitions can only be used after the last day to withdraw in a semester (50% of the class enrollment period), the
only exception is Military Withdrawal. Petition to Withdraw must be submitted to the campus attended for each
course. It is beneficial for you to speak to your instructors concerning your need to withdraw from classes.
2. With few exceptions, the student must be withdrawn from
-
all classes in the semester for which the petition is
being requested. The majority of these exceptions entail:
a) Physical or Medical Withdrawal from a PE/DANCE class.
b) Retaining a Short-term class that has been completed prior to the need to withdraw.
c) Retaining 100% Web classes that can be ‘attended’ at
home.
3. Petition must be submitted no later than the end of the semester following the semester in which the
extenuating circumstances occurred (include only Spring and Fall in this determination).
4. The reason for the withdrawal must be for circumstances
outside the student’s control and
must be fully
verifiable and documentation by a reliable third party.
II. REASONS FOR WITHDRAWAL:
•
.
III. IMPORTANT NOTES:
1. All required documentation must be submitted with completed petition. Incomplete submissions will be denied
and returned to the student.
2. Upon acceptance of the petition, Admissions & Records may consult with the Instructor of record for each class.
3. Please allow at least 30 working days from receipt of your petition for processing.
4. Student will receive a copy of the petition with the results once all necessary reviews have been completed.
Withdraw_Extenuating_Circumstances_ACC 071519
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ffE Fresno City PETITION TO WITHDRAW UNDER EXTENUATING (Fresno City College)

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Completed 4 September 2020

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