Form Instructions

Please follow the listed steps below to complete and submit the available forms.
  1. Complete the requested form information, date and type your full name as your signature and click 'Email Form to Admissions' button at the bottom of the form.
    Note: Required field titles are in red.
  2. Repeat above step until submission is accepted with no validation prompts.
 
Contact Information
*Enter as xxx-xxx-xxxx
7 Digit Student ID Required
Third Repeat Request
Student Email Address Enter in format @email.vccs.edu

Students are normally only allowed to enroll in the same course twice. If a student wishes to repeat a course for the third time, they must obtain approval by completing the sections below and submitting this form to the Welcome Center.

Course Number Course Subject-Section Credits Term
Please state reason for request and plan for succeeding during the third attempt:


By registering for the course and by signing below, you agree to the terms and conditions of this repeat course approval.

Typed Signature is Required Student Signature Date Required