Fillable Financial Aid Appeal Form (Berkeley City College)

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Financial Aid Appeal Form (Berkeley City College)

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The Financial Aid Appeal Form (Berkeley City College) form is 2 pages long and contains:

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  • 14 check-boxes
  • 41 other fields

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File type: PDF

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2019-2020
Financial Aid Appeal Form
Last Name:
First Name :
Student
ID#:
Address City State/Zip Phone
#
This Appeal form is for students who are on Financial Aid Dismissal due to one or more of the
following reasons: (Please check all boxes that apply)
Grade Point Average is below
2.0 –
Cumulative
Completed Less than
66.7% of attempted units - Term and
Cumulative
Completed and/or attempted more than 150% of declared
academic major
INSTRUCTIONS
Complete and submit ALL required items outlined below to the Financial Aid Office.
The
information provided on this Appeal
Form will ultimately determine your eligibility to receive Financial
Aid.
1.
Complete this form and select which reason you are appealing for the affected semester. Also provide documentation
to
support extenuating circumstance that pertains to your case.
Must select one:
Death of immediate family member (copy of obituary or death certificate)
Serious illness or injury (physician’s note)
Involuntary job transfer or military service (official notice on company letterhead or military orders)
Recalled in support of national emergency (official notice)
Victim of crime (police report number or letter from service agency)
Institutional error (written verification from BCC faculty/staff)
Natural disaster/evacuation
(official notice)
New career path/Job Loss (personal statement of loss in employment leading to change in career path)
2. Complete “The Key Components to the Satisfactory Academic Progress (SAP) Financial Aid Appeal Process” section by visiting:
https://berkeleycitycollege.get-counseling.com/
(print out confirmation of completion)
3. Submit Student Comprehensive Educational Plan (SEP) developed by counselor to demonstrate potential successful completion.
4.
How do you plan to be successful and what strategies are you adopting in order to meet the requirements of satisfactory
academic progress:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Term Applying for Appeal:
Fall___ Spring___ Summer___
DEADLINES to Submit App
e
a
ls
:
□ Fall Semester – November 15
th
2019
□ Spring Semester – April 17
th
2020
□ Summer Semester – July 10
th
2020
S
tudent Name (Please Print) Student ID #
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
DATE:
STUDENT’S SIGNATURE:
___________________________________________ ___________________
T HI
S
S E C
T IO N
F O
R COU N S E L O R C ER T I F I CAT I O N
A N
D COM M E N T
S
►Student’s Education Objective at
PCCD:
)
[ ] AA/AS – (Degree
Major:________________________________________________
)
[ ] Certificate -
(Type:____________________________________________________
)
Potential
college:
[ ] Transfer - (Program Major:
_____
____
____
_____________________
__________________________
►Student’s Expected Completion Date at PCCD:___
____________
____ ►Counselor’s Comments (optional): ____ ____ ____ _____ ____ ____ ____
_______________________
______________________________________
_________________________________________________________________
_________________________________
__
______________________________________
_______________________________________________________________
_________________________________
Date: Counselor’s signature: ----------------------------------------------------------------------- --------------------------------------------
STUDENT CERTIFICATION: I certify that all statements and/or supporting documentation are true and correct to the
best of my knowledge. Any false statement or misrepresentation will be cause for denial. The appeal decision is
FINAL. I acknowledge that I have read the Peralta Community College District’s Satisfactory Academic Progress (SAP)
policy. To view the SAP policy visit: http://web.peralta.edu/financial-aid/sap/
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Financial Aid Appeal Form (Berkeley City College)

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Completed 3 September 2020

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