Petition to Extend Enrollment
Name:
Phone:
College:
Extension Adjustments (College office use only)
SID:
E-mail
Major(s) & Minor
@ucsc.edu
Is the student attending UCSC on an F-1 or J-1 visa?
Yes or
No
(circle one)
Remaining General Education/University requirements:
As of the end of
Quarter, 20
Total credits earned ______ + Total credits in plan ______ = Total
Adjustments for students who enter with fewer than 90 transfer credits:
Total transfer credit:
Adjustment for AP and/or IBH credits:
Adjustment for summer transfer credits after matriculation:
Adjusted transfer credit total:
- ______________
-
Adjusted transfer credit ÷ 15 = equivalent quarters
Remaining Major/minor requirements:
Regular UCSC quarters (FWS) completed: [
Total Quarters Completed:
Quarters Remaining:
15th quarter equivalent:
Part-time]
+
Adjustments for students who enter with 90 or more transfer credits:
Academic plan to complete degree requirements
Fall
UPT?❏
Wtr.
UPT?❏
Total Credits:
Total Credits:
Fall
Wtr.
UPT?❏
UPT?❏
Spr. UPT?❏
Total Credits:
Spr.
UPT?❏
Summer
Total Credits:
Summer
_______________
Allotted Quarters
Transfer credit since admission:
_______________
Adjustment for summer transfer credits - _______________
Adjusted transfer credit total:
Adjusted transfer credit ÷ 15 = equivalent quarters
_______________
Regular UCSC quarters (FWS) completed: [__ Part-time] + _______________
Total Quarters Completed:
_______________
_______________
Quarters Remaining:
_______________
9th quarter equivalent:
Final approved quarter:
Entered AIS
Extension granted beyond 5 years (3 for transfers) Yes or No (circle one)
Number of extra quarter ___________ Number of extra credits
Total Credits:
Total Credits:
Total Credits:
Total Credits:
Department Signature Required: Yes or No (circle one)
The above plan will allow the student to complete all major/minor requirements
Major Advisor
Date
2nd Major/Minor Advisor
Date
If student is on F-1 or J-1 visa, has ISS been consulted? o Yes o N/A
NOTES:________________________________________________________________
_______________________________________________________________________
College Approval
Date
Provost Approval beyond 5 or 3 years
Date
Revised 1/2017