ACADEMIC FORGIVENESS APPLICATION
REPRIEVE PROVISION
,AM APPLYING FOR A HEALTH CARE PROGRAM
PLEASE NOTE: Requests are reviewed in order of their receipt. While the GET office strives to process forgiveness requests as
quickly as possible, your request could take up to four weeks during holidays, graduation, and heavy periods of enrollment.
You will be notified of the status of your reprieve request through your OCCC email.
Last Name
First Name
M.I.
Student Email Address
Social Security Number
OCCC ID#
Home Phone Number
(include area code)
Academic Forgiveness under the Reprieve provision can be granted for up to two consecutive semesters in which the semester grade point average
was lower than a 2.00. The following criteria must be met to be eligible for the Reprieve provision:
- Three years must have elapsed since the semester(s) in request of reprieve.
- 12 hours of regularly graded coursework must have been completed since the semesters in request of reprieve.
- No grades of lower than a "C" in regularly graded coursework can be earned in any semesters after the
semester(s) in request for reprieve. Regularly graded coursework excluded zero-level or remedial classes
- No prior Academic Renewal or Academic Reprieve can exist on the academic record.
Please indicate the semester(s) you wish to have reprieved below:
Semester 1
Institution Attended:
Semester/Year:
Semester 2 (if applicable)
Institution Attended:
Semester/Year:
I understand that all current, official transcripts from previously attended institutions must be submitted for OCCC to
process my request for Academic Forgiveness.
I understand that the reprieve will be awarded for all earned and attempted hours in the semester(s) which I am
requesting. This means that I will not receive credit for any courses or proficiencies passed during the
reprieved semester(s). If I passed a course in my reprieved semesters that I need for my degree, I will not be
required to retake the course, but I will be required to take an additional course to replace the reprieved credit hours.
I understand that any Academic Forgiveness that is processed to my record will adjust my Retention and future
Graduation GPAs only. My Cumulative GPA and/or my Graduation GPA from a previously conferred degree will not
be adjusted.
By submitting this form, I consent for OCCC to review my eligibility for the academic forgiveness renewal option and to apply the forgiveness
to my coursework if I meet all requirements.
_________________________________________________
Student’s Signature
Submit
_____________________________________
Date
I understand that, by submitting this form online, I am
providing an accurate and true electronic signature
and that my request may be delayed or not processed
if any information is incorrect/omitted .
REV. 7/16
OFFICE USE ONLY:
Select One:
Reprieve Approved
Reprieve Denied
If Denied, Provide Reason:
Processed By:
Date:
Approved By:
Date: