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Follow the directions carefully: if the form is not completed correctly you will not be allowed to register for both classes. \par }\pard\plain \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\f1\insrsid11676581 \par }{\b\f1\fs22\insrsid11676581 Date: ______________________ Semester: _______________________ \par \par GCC ID: ____________________ Soc. Sec. #: __________________________ \par \par }\pard\plain \s2\ql \li0\ri0\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \b\f1\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs22\insrsid11676581 \par Student's Name: ________________________________________________________________ \par }\pard\plain \s3\ql \li0\ri0\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel2\adjustright\rin0\lin0\itap0 \b\f1\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid11676581 Last, First MI \par }\pard\plain \s2\ql \li0\ri0\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \b\f1\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs22\insrsid11676581 \par Student\rquote s Signature: ____________________________________________________________ \par }\pard\plain \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\f37\fs22\cf2\insrsid11676581 \par STEP 1 - List the class for which you will have to make up time. \par }\pard \ql \li0\ri0\widctlpar\brdrt\brdrs\brdrw10\brsp20 \brdrl\brdrs\brdrw10\brsp80 \brdrb\brdrs\brdrw10\brsp20 \brdrr\brdrs\brdrw10\brsp80 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 \shading500\cbpat8 {\b\f1\insrsid11676581 \par }\pard \ql \li0\ri0\widctlpar\brdrt\brdrs\brdrw10\brsp20 \brdrl\brdrs\brdrw10\brsp80 \brdrb\brdrs\brdrw10\brsp20 \brdrr\brdrs\brdrw10\brsp80 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 \shading500\cbpat8 {\b\f1\insrsid11676581 Ticket #: _________ Course Name: ______________ Days/Time: _________________ \par \par }{\b\i\f1\insrsid11676581 Instructor use only \par }{\i\f1\insrsid11676581 Will the student be missing any time from your class? }{\field\flddirty\fldpriv{\*\fldinst {\i\f1\insrsid11676581 FORMCHECKBOX }{\i\f1\insrsid11676581 {\*\datafield 650000001400000006436865636b3100000000000000000000000000} {\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}{\i\f1\insrsid11676581 Yes }{\field\flddirty\fldpriv{\*\fldinst {\i\f1\insrsid11676581 FORMCHECKBOX }{\i\f1\insrsid11676581 {\*\datafield 650000001400000006436865636b3200000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check2}\ffdefres0}}}}{\fldrslt }}{\i\f1\insrsid11676581 No \par }\pard \ql \li0\ri0\widctlpar\brdrt\brdrs\brdrw10\brsp20 \brdrl\brdrs\brdrw10\brsp80 \brdrb\brdrs\brdrw10\brsp20 \brdrr\brdrs\brdrw10\brsp80 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 \shading500\cbpat8 {\b\i\f1\insrsid11676581 \par }{\i\f1\insrsid11676581 Indicate the amount of time the student will miss from your class, and explain how the student will make up the time missed. }{\b\i\f1\insrsid11676581 The time must be made up under the supervision of the instructor}{ \i\f1\insrsid11676581 . \par }{\b\f1\insrsid11676581 ______________________________________________________________________________________ \par \par ______________________________________________________________________________________ \par \par Instructor's Signature: _______________________________________________Date: ______________\tab \tab \tab \tab \par }\pard \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \cbpat8 {\b\f37\cf2\insrsid11676581 \par }{\b\f37\fs22\cf2\insrsid11676581 STEP 2- List the conflicting course. \par }\pard \ql \li0\ri0\widctlpar\brdrt\brdrs\brdrw10\brsp20 \brdrl\brdrs\brdrw10\brsp80 \brdrb\brdrs\brdrw10\brsp20 \brdrr\brdrs\brdrw10\brsp80 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 \shading500\cbpat8 {\b\f1\insrsid11676581 \par Ticket #: _________ Course Name: ______________ Days/Time: _________________ \par \par }{\b\i\f1\insrsid11676581 Instructor use only \par }{\i\f1\insrsid11676581 Will the student be missing any time from your class? }{\field\flddirty\fldpriv{\*\fldinst {\i\f1\insrsid11676581 {\*\bkmkstart Check1} FORMCHECKBOX }{\i\f1\insrsid11676581 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}{\i\f1\insrsid11676581 {\*\bkmkend Check1} Yes }{\field\flddirty\fldpriv{\*\fldinst { \i\f1\insrsid11676581 {\*\bkmkstart Check2} FORMCHECKBOX }{\i\f1\insrsid11676581 {\*\datafield 650000001400000006436865636b3200000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check2}\ffdefres0}}}}{\fldrslt }}{ \i\f1\insrsid11676581 {\*\bkmkend Check2} No \par }\pard \ql \li0\ri0\widctlpar\brdrt\brdrs\brdrw10\brsp20 \brdrl\brdrs\brdrw10\brsp80 \brdrb\brdrs\brdrw10\brsp20 \brdrr\brdrs\brdrw10\brsp80 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 \shading500\cbpat8 {\i\f1\insrsid11676581 \par Indicate the amount of time the student will miss from your class, and explain how the student will make up the time missed. }{\b\i\f1\insrsid11676581 The time must be made up under the supervision of the instructor. }{\b\f1\insrsid11676581 \par }{\b\f1\insrsid11676581 ______________________________________________________________________________________ \par \par ______________________________________________________________________________________ \par \par Instructor's Signature: _______________________________________________Date: ______________ \par }\pard \ql \li0\ri0\widctlpar\brdrt\brdrs\brdrw10\brsp20 \brdrl\brdrs\brdrw10\brsp80 \brdrb\brdrs\brdrw10\brsp20 \brdrr\brdrs\brdrw10\brsp80 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 \shading500\cbpat8 {\i\f1\insrsid11676581 \par }\pard\plain \s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \cbpat8 \i\f1\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid11676581 \par }{\f38\insrsid11676581 INSTRUCTORS PLEASE NOTE: California Education Code Section 88240 and Title V Section 58056 require that hours be made up outside of the class be under the supervision of a certificated employee. \par }\pard\plain \s4\ql \li0\ri0\keepn\widctlpar\aspalpha\aspnum\faauto\outlinelevel3\adjustright\rin0\lin0\itap0 \cbpat8 \b\f37\fs22\cf2\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid11676581 \par STEP 3 - Submit completed form to the Admissions & Records Office \par }\pard\plain \ql \li0\ri0\widctlpar\brdrt\brdrs\brdrw10\brsp20 \brdrl\brdrs\brdrw10\brsp80 \brdrb\brdrs\brdrw10\brsp20 \brdrr\brdrs\brdrw10\brsp80 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 \shading500\cbpat8 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\f1\insrsid11676581 Office Use Only: }{\field\flddirty\fldpriv{\*\fldinst {\b\f1\insrsid11676581 {\*\bkmkstart Check3} FORMCHECKBOX }{\b\f1\insrsid11676581 {\*\datafield 650000001400000006436865636b3300000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check3}\ffdefres0}}}}{\fldrslt }}{\b\f1\insrsid11676581 {\*\bkmkend Check3} Approved }{\field\flddirty\fldpriv{\*\fldinst { \b\f1\insrsid11676581 {\*\bkmkstart Check4} FORMCHECKBOX }{\b\f1\insrsid11676581 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{ \b\f1\insrsid11676581 {\*\bkmkend Check4} Denied \par }\pard \ql \li0\ri0\widctlpar\brdrt\brdrs\brdrw10\brsp20 \brdrl\brdrs\brdrw10\brsp80 \brdrb\brdrs\brdrw10\brsp20 \brdrr\brdrs\brdrw10\brsp80 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 \shading500\cbpat8 {\b\f1\insrsid11676581 \par Dean of Admissions & Records Signature: __________________________________Date: __________ \par \par }\pard\plain \s16\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \cbpat8 \b\f37\fs20\cf6\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs16\insrsid11676581 \par Students must officially add \'93Time Conflict Courses\'94 in person, in either the Admissions Office or in AA-1, during Walk-Through Registration. }{ \b0\f38\fs16\cf0\insrsid11676581 Revised 3/05 \par }}