2016 PETITION FOR MESA GRADUATION
This form will be used to determine if you are eligible for MESA Graduation. Students who meet the MESA
Graduation Requirements will be honored at the MESA Awards Banquet on May 28, 2016. You will be notified by
your MESA Advisor if you are eligible for MESA Graduation. If you have any questions regarding MESA
Graduation or how to complete this form, please contact the CSU Fresno MESA Office at 559.278.2976.
Instructions:
1.
Complete this form—responses must be typed or printed legibly in black or blue ink. Make sure to
answer all questions.
2.
Attach the following information to the petition:
a. Unofficial transcripts (including final grades for the first semester of this academic year)
b. One page essay (see below for topic)
3.
Return the completed form to your advisor. All forms are due by 5:00 p.m. on Thursday, May 5th,
2016.
Late petitions will not be accepted—No Exceptions!
STUDENT INFORMATION:
Name: _____________________________________________ School: _________________________________
Address: ______________________________________ City: __________________ State: CA Zip: _________
Home Phone: _____________________ E-Mail: ____________________________________________________
Number of Years as a MESA Student (including this year): __________
SAT I:
Verbal Score________ Math Score ________ Writing Score________ Total Score ________
ACT:
English/Writing Score ____ Math Score ____ Reading Score ____ Science Score ____ Composite Score ____
UNIVERSITY/COLLEGE INFORMATION
List your top two Universities/Colleges that you have applied to and check the status that applies
#1 Choice: ___________________________________________ Major: _________________________________
Accepted? YES ______ NO ______ DON’T KNOW YET (provide date you will know) ___________________
#2 Choice: ___________________________________________ Major: _________________________________
Accepted? YES ______ NO ______ DON’T KNOW YET (provide date you will know) ___________________
Where will you attend? ___________________________________________
ESSAY TOPIC
On a separate sheet write in essay format how the MESA Schools Program has contributed to your personal
academic achievement, career and educational goals, and leadership development (one page maximum).
MESA AWARDS BANQUET
____ Yes, I will attend the MESA Awards Banquet on May 28, 2016
____ No, I am unable to attend the MESA Awards Banquet
SIGNATURE
To the best of my knowledge, the information provided is complete and accurate.
Student Signature: ___________________________________________________ Date: ____________________
MESA Advisor’s Signature: ___________________________________________ Date: ____________________
MESA GRADUATION REQUIREMENTS
Certificate of Graduation
 4 years of College Preparatory Mathematics
 4 Years of College Preparatory English
 Chemistry or Physics
 Minimum Cumulative GPA = 3.0
 MESA Schools Program Participation
Outstanding Achievement Certificate of Graduation
 4 Years of College Preparatory Mathematics
 4 Years of College Preparatory English
 Chemistry AND Physics (an AP science class
can be substituted for one of these)
 Minimum Cumulative GPA = 3.3
 Minimum 2 yrs. MESA involvement (senior
year must account for one of them)
 MESA Schools Program Participation
(Leadership participation a plus)
GRADUATION APPEALS/MESA ADVISOR WRITTEN RECOMMENDATIONS
CSU Fresno MESA will strictly follow the graduation requirements listed above when determining who is eligible
for MESA graduation. Only MESA Advisors may submit an appeal in the event that a student does not meet the
requirements. Appeals should consist of a written recommendation letter explaining why the student should receive
this award and why the above requirements were not met. Late appeals will not be accepted—no exceptions.
FOR OFFICE USE ONLY
[ ] Eligible to Graduate
Award Type:
[ ] Certificate of Graduation
[ ] Outstanding Achievement
[ ] Four Year
[ ] Five Year or More
[ ] Not Eligible to Graduate
Reason:
[ ] Missed Deadline, Date Rec’d _______
[ ] Transcripts Missing
[ ] Essay Missing
[ ] Low Cumulative GPA
[ ] Incomplete Form
Appeal:
[ ] Accepted
[ ] Declined