Date:
Administrator Signature:
OFFICE USE:
Approved Denied
LOSS OF PRIORITY REGISTRATION AND CALIFORNIA COLLEGE PROMISE GRANT APPEAL FORM
Please print clearly and legibly - Return completed appeal and proper documentation to college Admissions & Records
Office. If appeal is related to loss of Promise Grant only, it may be routed to the college Financial Aid Office for processing.
NAME STUDENT ID #
CONTACT PHONE # TERM
LOS RIOS GMAIL @apps.losrios.edu COLLEGE
I am requesting a one-time reinstatement of my priority registration and/or California College Promise Grant (formerly BOG
or Board of Governors Fee Waiver) for the following reason(s):
Check all that apply.
Extenuating Circumstances - verified cases of
accidents, illnesses or other circumstances beyond
the control of the student. (Registration and Promise
Grant) Attach documentation to verify your
extenuating circumstances.
Change in your economic situation (Promise Grant
Only) Attach a written statement that describes your
situation
I receive services through CalWorks, EOPS, DSPS or
Veterans. (Promise Grant Only)
Students who lose their Promise Grant eligibility due to
academic or progress probation may receive special
consideration for reinstatement based on the factors related
to their participation in CalWorks, EOPS, DSPS or being a
Veteran. Please attach any explanation of factors that may
have caused you to be placed on academic or progress
probation
Enrollment in courses required for a high unit major
or program (Registration and Promise Grant)
High unit majors generally include preparation for transfer
programs in Allied Health, Architecture, CIS, Engineering,
Math and Sciences, Medicine, or other areas. You must have
a Comprehensive Education Plan detailing one of the listed
high unit programs. Attach a copy of your current student
education plan.
Academic and/or progress improvement
(Registration
and Promise Grant)
Students who lose their priority enrollment due to academic
or progress probation must demonstrate significant academic
improvement to appeal the loss of priority registration status.
Evidence of such improvement is defined as achieving no less
than the minimum GPA (2.0) and progress standard (less than
50%) for the term or terms. Attach copy of Los Rios
transcript.
Unable to obtain essential support services
(Promise Grant Only)
Attach evidence that you were not able to obtain support
services.
I lost eligibility for priority registration because I did
not complete the steps to success, but I have now
completed them. (Registration Only)
The Los Rios Community College District requires Continuing
Students to have completed Orientation, Assessment, and an
Educational Plan to be eligible for priority registration.
Attach evidence that you have completed these steps.
I have a disability and applied for but did not receive
a timely, reasonable accommodation. (Registration and
Promise Grant)
Attach a written statement that describes your situation and
documentation from DSPS verifying the situation.
Student’s Signature: Date:
Final 2/8/2018
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