Student Petition Form - Sacramento City College
ADVERTISEMENT
1
2Staff Initials & Intake Date: ______________________
Date Stamp:
A
& R
O
DMISSIONS
ECORDS
FFICE
Student Petition Form
Please complete the following. PRINT legibly and clearly
.
Student Name:
_________________________________________________
Student ID:
_____________________________
Address:
Phone:
______________________________________________________
(_______)________________________
Street
Apt
Email:
______________________________________________________
_________________________________
City
State
Zip
Action Requested: Please check the applicable box. Refer to instructions on reverse side.
□
□
Unauthorized Course Repeat
Late Add
□
□
_______________________________
Late Drop (Medical or Military)
Other:
Semester and Year Applicable:
□
□
□
_________
Summer
Fall
Spring
Year:
Courses Affected:
Class Number (five digit code)
Course Name and Number (i.e. ENGWR 100)
Student Statement: Please provide a written explanation (required) and attach supporting documents (Late Drop).
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Student Signature: _______________________________________________________ Date: _____________________
For Unauthorized Course Repeat:
□
□
Counselor Recommendation: _______________________________________________________
Recommend
Do Not Recommend
_______________________________
Counselor Signature:
Print Counselor Name: __________________________________________
Date
For Late Adds:
Professor Recommendation: _______________________________________________________ First Day of Attendance: _______________
□
□
__________________________________________
Recommend
Do Not Recommend
Professor Name & Signature:
Date
For Late Adds:
Dean Recommendation: _______________________________________________________________________________________________
□
□
_____________________________________________
Recommend
Do Not Recommend
Dean Name & Signature:
Date
□
□
□
Your Petition has been reviewed and your request has been:
Approved
Denied
Returned
_______________________________________________________________________________________________
Comments:
□
□
□
□
Posted
OnBase
Emailed
Bus Office
Review Committee: ______________________________ Date: ______________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal