EOP&S/CARE/NextUp Student Petition

Complete the EOP&S Student Petition if you did not meet program requirements outlined in the EOP&S Student Mutual Responsibility Contract (MRC) due to an extenuating circumstance (e.g. COVID-19, flood, fire, illness). Documentation should be provided via this form. The Spring 2020 EOP&S Student Petition deadline is pending at this time. Petition decisions will be emailed within ten (10) business days after the petition deadline.

Name*

First Last

Lancer ID*

LancerPoint Email*

Enter Email Confirm Email

Major*

Phone*

Reason(s) for Petition*

Please check all that apply.

Did not complete enrollment requirement (Continuing Student 9-12+ Units, New Students 12+ Units). DSPS students must provide a CAP Form/Accommodations Plan/Letter from DSPS each term.
G.P.A below 2.0 for Spring 2020 term
Did not complete three contacts by the June 19, 2020 deadline
Other

Other reason for petition*

Please briefly explain why you did not meet the program requirement(s)*

Have you spoken to an EOP&S counselor/coach/staff regarding this petition?*

Yes
No

Student Certification 1*

I understand that it is my responsibility to complete all program requirements stated in the Student Mutual Responsibility Contract that I signed when I was admitted to EOP&S/CARE/NextUp Program.

Student Certification 2*

I understand that if I am experiencing difficulties I must notify an EOP&S/CARE/NextUp Counselor/Success Coach and follow the recommendations of the Counselor/Success Coach such as: seeking tutoring, attending group counseling workshop, etc.

Student Certification 3*

I understand that I may be dismissed from the EOP&S/CARE/NextUp program for failing to complete program requirements. Please refer to the student Mutual Responsibility Contract.

If applicable, please provide supporting documentation

Examples of acceptable documentation are doctors' notes, accident reports, and any third-party verification that substantiates your claim.

Drop files here or

Signature*

Typing your name in this box will verify your acknowledgment of obligation

Phone

This field is for validation purposes and should be left unchanged.