First Name
Last Name
Email Address
Student ID Number
Mailing Address
Mobile Phone
Birthdate
Specify the semester for which you are requesting an exception to a college policy.*
What major/certificate are you wanting to study?
How many credits did you attempt last semester?
How many credits are you registered for/planning to register for?
Do you plan to work during the upcoming semester?
How many hours per week are you planning to work?
Did you recieve any type of financial aid in the last two semesters?
Have you been placed on Financial Aid Suspension?
Do you have (or suspect that you have) any type of disability (learning, cognative, emotional, physical)?
Are you a veteran?
Where do you live?
Do you have roommates?
How many roommates do you have?
Do you currently, or have you in the past, used any of the following Casper College services and/or participated in any school sponsored events?
If you selected 'Other' above, please specify.
When do you typically study?
Where do you typically study?
How many hours per week do you typically spend studying?
Do you struggle with studying (reading assignments, doing homework, studying for tests)?
What makes studying difficult?
Please identify any factors that may have contributed to academic difficulty by checking all items that apply.
Please describe your last two semesters at Casper College and what things and/or situations have contributed to your current academic standing?
What went well last semester?
What concerns do you have about your current situation (suspension)?
What do you think would have to change in order for you to be successful in the upcoming semester?
Of the changes listed above, which would be the biggest challenge and why?
Of the things you can control, which ones are you MOST likely to improve upon in the upcoming semester?
Do you understand that if your petition is approved, you are required to participate in regular meetings with the Student Success Counselor?
Do you understand that you MUST schedule a petition review meeting with the Student Success Counselor to review this petition BEFORE the Suspension Committee will make a decision?
Do you understand that your petition may not be accepted and, if so, you will not be able to return next semester?
Do you understand that you must submit official documentation, if applicable?
Student Signature - Please Type Your Full Name
