Prerequisite Challenge Form for Chabot College

(Print it, fill it out, and Submit completed form and documentation to Counseling Front Desk, Bldg. 100 or to your Counselor)

Name: ______________________________________________________________ SSN: ____________________

Address: ____________________________________________________________ Phone: __________________

_ .............___________________________________________________________

Course I wish to take:

Prerequisite/Requirement I wish to Challenge:

(Prerequisite Challenge must.be filed prior to the first day of the term.)

Check the box which applies to you: Please attach all pertinent documentation to this form.

O I have the knowledge or ability to succeed in the course. I have completed ________________
________________________________________me for the course I wish to take.

O The prerequisite has not been made reasonably available. Please explain: ........________________________________________________________________________

O The prerequisite is established in violation ofregulation and/or district-approved processes. Please explain: _____________________________________________________________

O The prerequisite is discriminatory or applied in a discriminatory manner. Please explain: .......________________________________________________________________________

I understand that Chabot College has determined that this prerequisite is necessary for success in the course and that I am taking personal responsibility for succeeding without this prerequisite.

Student Signature: _____________________________________________________________

The appropriate instructors have evaluated the documentation and have O approved O disapproved the student's Prerequisite Challenge. Division Chair _______________________________________ Date ________________

For Office Use Only.................................................. Date Received __________________ Received by: _________ Form Complete _____ Documentation attached ______________ Sent to: _________________________________________________________________ .........................Division ................................Name ...............................Date Received from Division: ________ Override Done: __________ Student Notified:_______

Distribution: [ ] Division [ ] Student [ ] Student File

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