Peralta Community College District, Admissions & Records
Office of the Vice Chancellor, Student Services
PETITION FOR COURSE REPETITION
STUDENT INFORMATION
NAME:
SSN:
Last
First
M.I.
(or Student ID #)
ADDRESS:
No. & Street
City
PHONE #:
State
Zip Code
EMAIL ADDRESS:
Requesting to repeat the following course: For:
Dept. &
College:
Course #:
Summer
Fall
Spring
Year:
Title:
Class #:
PART I: You can repeat a course for one of the following reasons. If you choose one of the following (A, B, C),
please take this form to the Admissions and Records Office for processing.
A. Repeat a course previously successfully passed because of a “significant lapse” of time which Peralta defines as
three (3) years. (Only one additional repetition due to significant lapse of time is permitted.) (Only the second grade
and units are counted in the gpa and unit totals.) ** [Title 5, section 55043].
B. Repeat a course for which a “substandard grade” (D, F, FW, NP, NC) was received. (Students may repeat the
course twice to alleviate a substandard grade. Only the highest grade and units will be counted for transcript purposes.)
Students should be advised that this is a procedure of the Peralta Community College District and may NOT reflect
procedures of four-year institutions. ** [Title 5, 55042.]
C. Repeat a course for which a “W” was received. (Student can only take a course four times for a W; the fifth
time a grade will be given. The last grade and units will be counted for transcript purposes.) [Title 5, 58161.5]
X
Student Signature
Date
ADMISSIONS & RECORDS USE ONLY
Student added to the requested class
Student was not added; did not meet the criteria
X
Initials
Date
PART II: You can repeat a course for one of the following reasons (D, E, F). If you choose one of the following,
please take this form to the Vice President or Dean of Student Services for processing (see page 2).
D. Repeat a course previously successfully passed because it “is necessary to meet a legally mandated training
requirement as a condition of continued paid or volunteer employment.” (The grade shall be included for purposes of
calculating the PCCD grade point average.) ** [Title 5, section 55041]. Please attach necessary documentation.
E. Repeat a course previously successfully passed because “another institution of higher education to which the
student seeks to transfer has established a recency requirement which the student will not be able to satisfy without
repeating the course in question.” (Only the second grade shall be included for purposes of calculating the PCCD grade
point average and unit totals.) ** [Title 5, section 55043]. Please attach necessary documentation.
F. Repeat a course previously completed because of “extenuating circumstances”. “Extenuating circumstances are
verified cases of accidents, illness, or other circumstances beyond the control of the student.” (The highest grade shall
be included for purposes of calculating the PCCD grade point average and unit totals.) ** [Title 5, 55045]. Please attach
necessary documentation.
X
Student Signature
Date
** When repeating a transfer course, please be aware that Peralta procedures may NOT reflect procedures of four-year institutions. Please see a counselor for
additional information.
Rev.: JBW 8/3/2010
Page 1
Peralta Community College District, Admissions & Records
Office of the Vice Chancellor, Student Services
VICE PRESIDENT OR DEAN OF STUDENT SERVICES USE ONLY
Approved
Denied
Student notified by:
Student Notified by:
Reason:
Phone
Email
In-Person
X
X
Name
Initials
X
Date
X
Vice President or Dean of Student Services Name (please print clearly)
Signature - Vice President or Dean of Student Services
Date
Please Note:
 After making the recommendation and informing the student of the decision, please return this form to the
Admissions and Records Office.
 If the request is “Approved”, Admissions and Records will register the student for the course listed on the
front side of this form.
ADMISSIONS & RECORDS USE ONLY
This form will be retained by Admissions and Record and all necessary transcript actions will be completed once
grades have been posted at the end of the term.
A&R action taken after the grade was posted.
X
Initials
Rev.: JBW 8/3/2010
Date
Page 2