San Joaquin Delta College

San Joaquin Delta College Office of Instruction 5151 Pacific Avenue Stockton, CA 95207 (209) 954-5050 Application for Time Conflict Code

To be considered for Approval, this form must be submitted to the Vice President of Instruction prior to the Census Day for the course in conflict.

Answer all of the questions listed below. Please type in your responses at the (___) and/or box. Use the “Tab” key to advance to the next field. Please attach a separate sheet when necessary.

Division Department

Date: Semester/Year:

Name of Student: Student SSN:

Conflicting Course: Name: Code:

Instructor’s Name:

Division Chair: Signature Date

As required by the California Community College's Chancellor's Office, briefly describe how the student will make up the hours of overlap in the course, (i.e., partially or wholly not attend as scheduled, at some other time during the same week, etc.) under the above instructor’s supervision?

Please state the day and time the student will meet with the instructor each week:

Click in a box to check it.

Monday Time Tuesday Time Wednesday Time Thursday Time Friday Time

Are the times you are meeting with the TBA student also during a regularly scheduled class or office hour? Yes No

The Instruction Office will create a TBA Code for the student and enroll the student once approved by the Vice President of Instruction. The Division will receive a signed copy of this form after completion. TO BE COMPLETED BY THE INSTRUCTION OFFICE:

Approved By:

Dr. Matthew Wetstein Date: TBA Code: Assistant Superintenden/Vice President Instructional Services

July 2008, November 2014 Revised