Cooperative Work Experience Education Course Repeat Petition Instructions for petition: • Student is to complete sections 1 and 2 of this form • Student is to meet with Work based learning program Coordinator to have section 3 completed • Student is to go to Admissions & Records office to complete section 4 and register for the course • An A&R Rep will scan/email copy of petition and send to the Work based learning coordinator upon completion of registration Section 1 – To be completed by Student -­‐ Complete the following contact information: Student Name:________________________________________ Student ID#________________________ Phone # __________________________ Email: __________________________________________________ Major or Area of Study: ______________________ Degree or Cerificate: ______________________ Section 2: -­‐ To be completed by Student -­‐ Complete the following course information: Course Number:________________________ Unit Value: _________ Academic Year: ___________ Semester (check 1) Fall_____ Spring _____ Summer _____ How many times have you taken this course in the past? _________________ 1.) Term/Yr __________ Grade __________ 2.) Term/Yr___________ Grade ___________ 3.) Term/Yr __________ Grade __________ 4.) Term/Yr___________ Grade ___________ Signature: ______________________________________________________________ Date: ____________________________ Section 3: To be completed by Work based learning Program Coordinator Course Number: ___________________________ Unit Value: _______________ Section #__________________ Add code: ______________(if submitted prior to Add/Drop deadline) Add Slip Given (if submitted after Add/Drop deadline) Yes ________ No ________ N/A________ CWEE Units earned to date_________ Repeat Approval: Yes _____________ No ______________ Signature: _________________________________________ Date: _______________________________ Section 4: To be completed by Admissions & Records Date: __________________ Registration completed by: ______________________________________ Updated: Feb 2014