Academic Renewal Petition Form - Tidewater Community College printable pdf download

SS-022

TIDEWATER COMMUNITY COLLEGE

From here, go anywhere.

Academic Renewal Petition Form

Please return this completed form to Enrollment Services and the Office of the College Registrar.

Student Name: _______________________________________________________________________________________________

Last

First

M.I.

Former Name(s): ___________________________________________________________________SIS ID:_____________________

Street Address: _________________________________________ City: ____________________ State: __________ Zip: __________

Telephone (Home): ___________________________(Work): _____________________________

I am or will be receiving Financial Aid: Yes ❑ No ❑

I am or will be receiving Veterans Benefits: Yes ❑ No ❑

As per § 5.7.0.5 of the Virginia Community College System Policy Manual, I believe that I meet the following eligibility requirements for

"Academic Renewal" and hereby petition to have my cumulative grade point average (GPA) adjusted accordingly:

1. I have been separated from the college for (at least) 5 years from ____________________ to _____________________ and

term/year

2. I have earned (at least) a 2.5 grade point average for the first 12 (twelve) credits completed after re-enrolling from my 5-year

separation. The qualifying "2.5 GPA based upon the first 12 (twelve) semester hours completed" is based on the entire

term(s) in which the 12 credit hours are achieved. A 2.5 GPA must be achieved based upon a calculation of all courses and

attempts within the qualifying period of re-enrollment.

3. Please indicate the Academic Renewal adjustment period that you are requesting. Note: Consecutive semesters/terms are

required. From ____________________ to ____________________

term/year

I understand that in receiving an Academic Renewal adjustment to my cumulative GPA:

• an Academic Renewal adjustment may be granted only one time;

• once granted by the College, Academic Renewal cannot be revoked;

• an adjustment will be made to my cumulative GPA by excluding all grades of "D" and "F" earned prior to the qualifying period

of re-enrollment;

• although my cumulative GPA will be adjusted in future terms, all of my previously earned grades will be shown on my

permanent record (including the excluded grades of "D" and "F");

• any course credit with a grade of "D" earned during the Academic Renewal adjustment period will not count toward future

graduation requirements;

• the Veterans Administration will not reimburse me for courses retaken in which I previously received a "D";

• an "Academic Renewal" notation will be made on my permanent record; and,

• the granting of Academic Renewal does not affect any previous academic, financial, or administrative determination made by

the college.

Student's signature: ___________________________________

Date: ___________________________

ENROLLMENT SERVICES OFFICE:

❑ Student Meets Eligibility Requirements

❑ Student Doesn't Meet Eligibility Requirements

Requirement Reviewed by: _________________________________________________ Date: ________________________________

OFFICE OF THE COLLEGE REGISTRAR:

Processed by: ___________________________________________ Date: _________________________________

10/14

Academic Renewal Petition Form - Tidewater Community College

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