il: C :
Admissions & Recruitment
Admissions Appeal
Sage Hall 1020
Name: Dolphin ID#:
Term and Year of Application
Ema ontact Number #
Current School Attendin
Attach a typed statement that explains your r eason for appealing. The personal statement must be
completed by the applicant. In order f or u s to best understand the nature of your appeal, please
use proper g rammar and punctuation.
Include documentation to verify any claims made in your s tatement regarding hardship, illness, or
other e xtenuating circumstances. A personal statement does not constitute documentation.
Letters of recommendation will not be considered. IMPORTANT: Documentation related to
sensitive personal or m edical issues should be the minimum necessary to understand your
hardship, illness, or o ther e xtenuating circumstance. Documentation will NOT be returned, so
please do NOT submit original copies.
If our l etter s tates that your a dmission was DENIED due to not being CSU eligible, then the
following documents must be ATTACHED to the Appeal form AND received by CI
within 15-business days of the date on your Denial Notice:
o A copy of your hi gh school transcript with sixth-semester grades posted. If you took
college courses, then you will also need to include an official copy of your c ollege
o Enrollment verification of courses enrolled for t he final semester o r c ourse
grades (if not listed on your transcript).
o A copy of your A CT or S AT Reasoning test scores.
o A copy of any AP/IB test scores (if applicable).
If our l etter s tates that your a dmission was rescinded or c ancelled because you failed to meet
an admission requirement(s), then the following documents must be received by CI within
15-business days of the date on your R escind/Cancellation letter:
o Transcripts not previously submitted directly to CI from all high schools and colleges
attended. CI will NOT accept unofficial transcripts when your a dmission was rescinded or
o Official test scores that were not previously submitted directly to CI by your s chool or t est
provider ( ACT and/or C ollege Board). CI will NOT accept unofficial test scores when your
admission was rescinded or cancelled.
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For individuals with disabilities must provide supporting documentation and historical verification
of their disability. CI will evaluate disability documentation using guidelines established by the
California State University (CSU) system. All appeals are reviewed on a case-by-case basis.
IMPORTANT: Documentation will NOT be used to determine accommodations if your appeal is
successful. Students must contact Disability Accommodation and Support Services (DASS) to
request services. Documentation provided as part of your appeal packet will NOT be shared with
DASS but will be treated in a professional and confidential manner.
If you missed the deadline for submitting final official transcripts and/or official AP test scores, you
must submit a Request for an Admissions Appeal within 15-business days from the deadline noted
in the Admissions Rescind Letter/email. Failure to adhere to deadlines is not likely to be viewed
favorably by the Admissions Appeal Committee. Students are responsible for complying with all
deadlines and instructions included in the Enrollment Guide.
Mail (fax and email NOT accepted) this form and supporting documentation to:
Admissions Office
RE: Admissions Appeal
CSU Channel Islands
Sage Hall 1020
One University Drive
Camarillo, CA 93012-8599
We strongly advise you to mail your completed appeal packet via priority mail or another
source where you can track its delivery. Due to the high number of appeals we receive, we
are unable to confirm receipt of your package.
If you are determined to be admissible, you will receive a letter in the mail offering you admission. If your
appeal is not successful, then you will receive an email notifying you of the outcome. Please allow 4
weeks for processing.
I have read the Admissions Appeals Process and above instructions and understand that I must submit all
documentation by the stipulated deadline or my packet will be considered incomplete. I further understand that
incomplete packets will be automatically denied and no further appeals will be allowed.
Signature Date
Date Reviewed:
Referred to Committee on:
Notes for Committee:
Date Reviewed by
Appeal Granted by Committee
Appeal Denied by Committee
Date Notification Sent:
Notification sent by:
Date PeopleSoft updated:
Admission Basis Code/Exception Reason: