Note: Foster Youth and Former Foster Youth (up to age 24) are exempt from lass of both priority registration and CCPG per regulation.
Last Name: _____________________________First Name: ________________________Student ID #_______________
YC Email: __________________________________________________Phone: ( )________-_____________
Minimum documents that must be included with this form as well as those identified below:
☐ A typed narrative of your situation AND an Approved YC Comprehensive Educational Plan
☐ Please indicate which term you are appealing to have your enrollment priority and/or CCPG reinstated
Summer _____ (Year) Fall _____ (Year) Spring _____ (Year)
☐ Copy of transcript
Enrollment Priority and CCPG Appeal Reasons: (REQUIRED check one)
☐ Academic/Progress Probation Extenuating Circumstances: documented illness, accident or circumstance beyond the control
of the student. (Examples of documentation are doctor’s notes, accident report, etc.)
☐ I have been making significant academic improvement by completing my last semester with 2.00+ GPA and completed
more than 50% of my semester coursework.
☐ I am a student with a verified disability who submitted a completed application before the first day of classes or within the
first two weeks of school but did not receive accommodations in a timely manner. (Attach verification of participation in the
DSPS program).
……………………………………………………………………………………………………………………………………………………………………………………………
Loss of California College Promise Grant (CCPG): (IF APPLICABLE check one)
☐ I was unable to obtain essential support services. (Please provide a written statement)
☐
I would like to be granted special consideration as I am a student in one of these programs (check all that apply)
(Written verification from each program must be attached to your Appeal form along with specific issue):
_____ CalWORKs _____ EOPS _____ DSPS _____ Veterans
☐ Economic Situation: Approval based on verified evidence of an economic situation, such as eviction, job loss and
homelessness, etc. To be considered, you must provide documentation, which may include such items as an eviction notice,
layoff or termination notice, unemployment statements, and statements from professionals on letterhead stationery, etc.
I declare under penalty of perjury that all information on this form is true and correct. I understand that this appeal form is void should I fail to make academic progress.
Student Signature: ________________________________________________ Date: _____________________________
Counselor Signature: ______________________________________________ Date: _____________________________
Loss of Enrollment Priority and/or California College Promise Grant* Appeal
This form is to appeal your enrollment priority and/or loss of CCPG
*formerly known as Board of Governors Fee Waiver (BOG)
OFFICE USE ONLY Review Date: ____________________________
Approve _____ Denied _____ Semester GPA ________ Cumulative GPA __________
Support Services/Follow up Recommended: ________________________________________________________________________________
____________________________________________________________________________________________________________________
Dean of Student Services Signature: _________________________________________________________ Date: ________________________
Student Notification Date: _____________ Financial Aid Office action completed: _____________ A&R action completed: _________________
