Academic Plan Restricted Course List Addendum
Last Name
First Name
Social Security Number
Student ID Number
Program or Major
I am requesting Financial Aid for the following term (select the term and enter the year)
Fall (year) or Spring (year) or Summer (year)
Since filing the original Academic Plan Restricted Course List (RCL) or Certificate/Occupational Course List (CCL), it
has become necessary to modify my RCL. (NOTE: A change of Degree /Certificate Program requires a
NEW Maximum Timeframe Appeal.) Notification of the Committee's decision will be delivered to your
Student Center within approximately 15 business days.
Please indicate if the course is ADDED, REPEATED, or a SUBSTITUTION. (For course substitution, the course it
is replacing must be listed.) Substitutions can only be approved for courses that have not previously been attempted
from your RCL. Course substitution may need approval from the Admissions and Records Department.
Course No.
Course Title
Provide a typed explanation as to why you and your Advisor did not identify the “Added,” or “Substituted”
course when your Academic Plan RCL was originally completed.
Provide a typed explanation as to why you did not successfully complete the course. Describe in detail, the
extenuating circumstances that prevented you from being successful. Explain how the circumstances have been
resolved and include what steps are being/will be taken to ensure success in the requested “Repeat course.
I am attaching documentation to support my appeal. (e.g. medical claims/statements; police reports; copy
of official death certificate/obituary; signed statement from an involved third party such as a counselor, priest,
rabbi, minister; documentation illustrating other commitments outside of school such as pay stubs, letter from
employer; etc.).
Certification and Signature
I certify that the submitted information is true and correct to the best of my knowledge and belief. If asked by an
authorized official, I agree to provide additional proof of the information provided on this form. I understand that
purposely providing false or misleading information on this form may result in reduction or repayment of aid, fines
and/or imprisonment in this and/or future years. I authorize the use of this information and any supporting
documentation for all MCCCD institutions.
Student’s Signature
PC Academic Advisor Signature
Non‐Discrimination Statement
The Maricopa County Community College District (MCCCD) is an EEO / AA institution and an equal opportunity employer of protected veterans and
with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual
orientation, gender identity,
age, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and
technical education programs of the
The Maricopa County Community College District does not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or
activities. For Title IX / 504 concerns, call the following number to reach the appointed coordinator: (480) 731‐8499. For additional information, as well
as a
listing of all coordinators within the Maricopa College system, visit‐discrimination.