College Course Repeat Request Form
Submit this form to request permission to retake a previously completed college course. Please provide accurate and complete information to support your request.
Student Name
*
First Name
Last Name
Student Email Address
*
example@example.com
Course Name and Code to be Repeated
*
Term and Year Course Was Previously Taken
*
Previous Outcome (e.g., Grade, Withdrawal, Incomplete)
*
Please Select
A
B
C
D
F
Withdrawal
Incomplete
Other
Reason for Requesting Course Repeat
*
Advisor or Instructor Name (if applicable)
Advisor or Instructor Email (if applicable)
example@example.com
Supporting Information or Comments
Upload Supporting Documents (optional)
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of
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