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Sec. #: ________-______-_______ DOB: ____________________ \par \tab \tab \tab \tab \tab \par \par Name: _______________________________________________________________________________________ \par }{\f1\fs16 Last First MI}{\f1 \par }{\b\f1 \par Address: _____________________________________________________________________________________ \par \par }\pard \qj \li0\ri0\widctlpar\brdrt\brdrs\brdrw45\brsp20 \brdrl\brdrs\brdrw45\brsp80 \brdrb\brdrs\brdrw45\brsp20 \brdrr\brdrs\brdrw45\brsp80 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \shading500\cbpat8 {\b\f1 \par Phone No: ( )__________________________ E-mail Address: ______________________________________ \par \par \par Student's Signature: __________________________________________________________Date: _____________ \par \par }\pard \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 \par \par Semester(s) for which Academic Renewal is requested: _______________________________}{\f1\fs16\chbrdr\brdrs\brdrw15 }{\f1\fs16 \par }{\b\f1\fs24 \par THE STUDENT MEETS THE FOLLOWING REQUIREMENTS: \par }{\f1\fs24 \par {\pntext\pard\plain\b\f1 \hich\af1\dbch\af0\loch\f1 1.\tab}}\pard \ql \fi-360\li360\ri0\widctlpar\jclisttab\tx360{\*\pn \pnlvlbody\ilvl0\ls1\pnrnot0\pndec\pnb1\pni0\pnfs24\pnstart1\pnindent360\pnsp120\pnhang{\pntxta .}} \aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0 {\f1\fs24 S tudent has provided evidence to the effect that the previously recorded work was substandard academic performance (semester grade point average less than 2.0) and is not reflective of more recently demonstrated academic ability. \par }\pard \ql \li0\ri0\widctlpar{\*\pn \pnlvlcont\ilvl0\ls0\pnrnot0\pndec }\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 \par {\pntext\pard\plain\b\f1 \hich\af1\dbch\af0\loch\f1 2.\tab}}\pard \ql \fi-360\li360\ri0\widctlpar\jclisttab\tx360{\*\pn \pnlvlbody\ilvl0\ls1\pnrnot0\pndec\pnb1\pni0\pnfs24\pnstart1\pnindent360\pnsp120\pnhang{\pntxta .}} \aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0 {\f1\fs24 Evidence of recent academic ability: \par }\pard \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 \par {\pntext\pard\plain\f14 \loch\af14\dbch\af0\hich\f14 \'d8\tab}}\pard \qc \fi-360\li360\ri0\widctlpar\jclisttab\tx360{\*\pn \pnlvlblt\ilvl0\ls4\pnrnot0\pnb0\pni0\pnf14\pnfs24\pnstart1\pnindent360\pnsp120\pnhang{\pntxtb \'d8}} \aspalpha\aspnum\faauto\ls4\adjustright\rin0\lin360\itap0 {\f1\fs24 15 semester units with at least a 3.00 G.P.A. \par }\pard\plain \s2\qc \li0\ri0\keepn\widctlpar{\*\pn \pnlvlcont\ilvl0\ls0\pnrnot0\pndec }\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \b\f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs20 OR \par {\pntext\pard\plain\f14 \loch\af14\dbch\af0\hich\f14 \'d8\tab}}\pard\plain \qc \fi-360\li360\ri0\widctlpar\jclisttab\tx360{\*\pn \pnlvlblt\ilvl0\ls4\pnrnot0\pnb0\pni0\pnf14\pnfs24\pnstart1\pnindent360\pnsp120\pnhang{\pntxtb \'d8}} \aspalpha\aspnum\faauto\ls4\adjustright\rin0\lin360\itap0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs24 30 semester units with at least a 2.50 G.P.A. \par }\pard\plain \s1\qc \li0\ri0\keepn\widctlpar{\*\pn \pnlvlcont\ilvl0\ls0\pnrnot0\pndec }\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs20 OR \par {\pntext\pard\plain\f14 \loch\af14\dbch\af0\hich\f14 \'d8\tab}}\pard\plain \qc \fi-360\li360\ri0\widctlpar\jclisttab\tx360{\*\pn \pnlvlblt\ilvl0\ls4\pnrnot0\pnb0\pni0\pnf14\pnfs24\pnstart1\pnindent360\pnsp120\pnhang{\pntxtb \'d8}} \aspalpha\aspnum\faauto\ls4\adjustright\rin0\lin360\itap0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs24 45 semester units with at least a 2.00 G.P.A. \par }\pard \qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 \par {\pntext\pard\plain\b\f1 \hich\af1\dbch\af0\loch\f1 3.\tab}}\pard \ql \fi-360\li360\ri0\widctlpar\jclisttab\tx360{\*\pn \pnlvlbody\ilvl0\ls1\pnrnot0\pndec\pnb1\pni0\pnfs24\pnstart1\pnindent360\pnsp120\pnhang{\pntxta .}} \aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0 {\f1\fs24 There must be at least 24 months between the end of the most recent academic renewal semester and the date of initiation of the request and such renewal. \par }\pard \ql \li0\ri0\widctlpar{\*\pn \pnlvlcont\ilvl0\ls0\pnrnot0\pndec }\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 \par {\pntext\pard\plain\b\f1 \hich\af1\dbch\af0\loch\f1 4.\tab}}\pard \ql \fi-360\li360\ri0\widctlpar\jclisttab\tx360{\*\pn \pnlvlbody\ilvl0\ls1\pnrnot0\pndec\pnb1\pni0\pnfs24\pnstart1\pnindent360\pnsp120\pnhang{\pntxta .}} \aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\itap0 {\f1\fs24 A student may request academic renewal only once for not more than two consecutive semesters. \par }\pard \qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b\i\f1\fs16\cf2 See College catalog for more details.}{\f1\fs16\cf2 \par }\pard \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \cbpat8 {\f1\fs24 \par }\pard\plain \s4\ql \li0\ri0\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel3\adjustright\rin0\lin0\itap0 \cbpat8 \b\f1\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {Admissions & Records Counselor\rquote s Signature: ___________________________________Date: ______________ \par }\pard\plain \qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \cbpat8 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\f29\cf6 \par }\pard\plain \s3\qc \li0\ri0\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel2\adjustright\rin0\lin0\itap0 \cbpat8 \b\f29\fs18\cf6\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {Student must submit completed form to the Admissions & Records Office \par }\pard\plain \qc \li0\ri0\widctlpar\brdrt\brdrs\brdrw45\brsp40 \brdrl\brdrs\brdrw45\brsp80 \brdrb\brdrs\brdrw45\brsp20 \brdrr\brdrs\brdrw45\brsp80 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \shading500\cbpat8 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\f30\fs18 OFFICE USE ONLY \par }{\b\f31 \par }{\b\f30 Petition: {\*\bkmkstart Check3}}{\field\flddirty\fldpriv{\*\fldinst {\b\f30 FORMCHECKBOX }{\b\f30 {\*\datafield 650000001400000006436865636b3300000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check3} \ffdefres0}}}}{\fldrslt }}{\b\f30 {\*\bkmkend Check3} Approved {\*\bkmkstart Check4}}{\field\flddirty\fldpriv{\*\fldinst {\b\f30 FORMCHECKBOX }{\b\f30 {\*\datafield 650000001400000006436865636b3400000000000000000000000000} {\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\b\f30 {\*\bkmkend Check4} Denied}{\f30 \par }{\b\f30\fs18 \par }\pard \ql \li0\ri0\widctlpar\brdrt\brdrs\brdrw45\brsp40 \brdrl\brdrs\brdrw45\brsp80 \brdrb\brdrs\brdrw45\brsp20 \brdrr\brdrs\brdrw45\brsp80 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \shading500\cbpat8 {\f1\fs18 GPA calculation: __________________________________________________________________________________________ \par \par __________________________________________________________________________________________ \par \par \par Admissions and Records Signature: ________________________________________________________Date: ______________ \par }{\b\f1\fs18 \par }}