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									                                               College of Liberal Arts
                                  ACADEMIC PROBATION CONTRACT

Student Name:                                    Student ID                              Major                              .

                This is my first quarter on Academic Probation. Quarter/Year                     /              .
                This is my second consecutive quarter on Academic Probation.
                I have been on Academic Probation before but not consecutively.

I am aware that due to poor academic performance during                        Quarter                 , my Grade Point Average
dropped below 2.0 for:    Term Total      CPSLO Cumulative                Higher Education

I understand that I am ineligible, while on probation, to hold A.S.I. leadership posts, or to participate in intercollegiate
athletics, debate, theater, or other instructionally related activities as specified in the Cal Poly catalog.

I hereby agree to: (department/advisor to mark applicable boxes)
                Complete a minimum of           letter graded units with a GPA of at least           in all classes.

                Complete, at the earliest opportunity, any course where a grade of ‘I’ has been earned.

                Repeat, at the earliest opportunity, any course where an ‘F’, ‘U’ or ‘NC’ was earned.

                Contact Student Academic Services ( to sign up for one or more of the following:
                study session program, tutor referral, and study skills seminars (time management, memory skills,
                listening, note taking, test preparation, test taking, etc.)
                             Specific Programs(s):

                Make an appointment at Counseling Services (Bldg 27-136, ph. 756-2511), which provides professional
                mental health, outreach, and educational services -- including stress management, individual counseling,
                and couples counseling.



This agreement will be placed in my student file. I have read and agree to the terms of this agreement. I realize
that failure to make satisfactory progress may prohibit my registration for subsequent quarters.

Student signature                                                     Date:

Advisor signature                                                     Date:
If applicable

Department Chair signature                                                       Date:                              .

Distribution: (1) Original: Student File (2) Copy: Student (3) Copy: Dean’s Office

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