Academic Renewal Application
EMAILED FORMS MUST BE SUBMITTED WITH YOUR MJC STUDENT EMAIL, OTHERWISE THEY WILL
NOT BE PROCESSED. Submit completed form by email to MJCESeForms@mjc.edu.
Student Information
First Name: Middle Initial: Last Name:
Student ID: w Phone Number: Date of Birth:
Student Email:
Modesto Junior College regulations permits work completed at MJC which is substandard and not reective of a student’s present scholastic
ability and level of performance to be disregarded. The approved course grades will be disregarded in the computation of the grade point
average under the following conditions:
• At least 1 year must have elapsed from the time the course work to be disregarded was completed.
• Must have completed at least 15 units of coursework (after the coursework to be disregarded was completed) either at MJC or
another institution. Evidence of recent academic ability includes the following:
• 15 to 29 semester units with a 3.0 GPA
• 30 to 44 semester units with a 2.5 GPA
• 45 or more semester units with a 2.0 GPA
Please note: If you have completed coursework at another institution, list the college(s) name and attach ocial transcripts.
College Name(s):
Additional Information:
•Up to 24 Units of coursework may be eliminated from consideration in the cumulative grade point average.
•Course(s) will NOT be considered if it was previously used to establish eligibility for transfer, graduation, or certicate(s) of achievement.
•You can only Academically Renew the most recent attempt in a course which has a substandard grade (D, F, NP, and/or NC).
•The permanent academic record shall be annotated in such a manner that all course work remains legible, ensuring complete academic
history remains.
Total Academically Renewed Units:
By signing below, I certify under penalty of perjury I am the student listed above and understand that by signing this form all information
listed is true and subject to approval.
Student Signature: Date:
OFFICE USE ONLY
Comments:
Sta Initials: Date: Student Notied Posted
MJC Enrollment Services • Phone (209)575-6853
EAST 435 College Avenue. Students Services Bldg. 1st Floor • WEST 2201 Blue Gum Avenue. Yosemite Hall 1st Floor
03/2020_SJB
Course Name Term
Units
Units/Grade Points
GPA Action
PLEASE LIST THE SUBSTANDARD COURSEWORK/GRADE(S) YOU ARE REQUESTING BE DISREGARDED FROM YOUR GPA:
- Oce Use Only -
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