Student Course Reevaluation Appeal

Course Reevaluation Appeal
Name

First NameLast Name
Student ID
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student Email
example@my.pbsc.edu
Each request must include:
- Completed Course Reevaluation form
- Catalog description of the course to be re-evaluated
- Course syllabus (if possible)
- Exact course ID number(s) from both previous institution and Palm Beach State College
- You may add multiple courses in the same form
*Student will be notified by mail as to the result of your reevaluation request.
Name of Transfer Institution
One form per institution
Transfer Institution
Palm Beach State Equivalent
Explain your reasons for submitting this appeal, and why you believe your request is justified. Be specific and be detailed.
Attach any documentation that supports your appeal.

Cancelof
By typing my full name below, I agree that all information provided in this form is accurate, complete, and truthful to the best of my knowledge.
Date

MonthDayYear
Should be Empty: