COURSE PREREQUISITE PETITION

Office of Admissions and Records

Name: _______________________________________ Student I.D. #:__________________
Last First M.I.
Address: _____________________________________ Date of Birth:__________________
Number Street Apt. #
Email:
__________________________________________________________________
City State Zip Code Phone Number:__________________


Directions: Complete form and submit with appropriate documentation to Admissions Office at least ten days before
the start of the semester. Petitions will be reviewed within 10 working days. Final notification will be mailed.

Course(s) requested: _________________________ Year:
_________________________ Winter Summer
_________________________ Spring Session 1
Fall Session 2
I have attached the following:

Transcripts from: ___________________________________________________________
College/University

Successful completion of the prerequisite course must be from institutions accredited by recognized regional
accrediting organizations. Unofficial transcripts can be used for prerequisite petitions, but will not be used for
academic or graduation purposes. Grades lower than C will not be considered.

Assessment Results from: _____________________________________________________
College/University

Appropriate placement by a California State approved and validated assessment process. Attach official advisement
placement documents. Test scores are valid for two years only.

Note: Courses approved by this petition does not determine course equivalency for graduation or transfer purposes.

Revised 9/2008 Office of Admissions
OFFICE USE ONLY

Intake Clerk:
Transcripts on WebXtender
Pick-up On:
Text
Student Signature: ___________________________________ Date: ____________________












Revised 9/2008 Office of Admissions

OFFICE USE ONLY
APPROVED DENIED

Course(s) Completed: -OR- Assessment level: Reason: _______________________________
(ELAC equivalency) (ELAC equivalency)

__________________ _______________ ______________________________________

___________________ _______________ Evaluated by: ____________________

________________ _____________ Date Notified: ____________________

Revised 11/2009 Office of Admissions