Peralta Community College
District Student Services
Loss of California Community College Promise Grant(CCPG)
Petition Form 2019-2020
Berkeley City College
College of Alameda
Laney College
Merritt College
This petition is for eligibility reinstatement to
the Community College Promise Grant Program. This “Loss of
CCPG
Petition form is not a Financial Aid Satisfactory Academic Progress (SAP) appeal.
Complete the student information part of
this petition form and a typed statement detailing your special
circumstances. Contact
the counseling department
to schedule an appointment for your CCPG petition.
Deadline to submit petition for the 2019-202
0 academic year: June 1
st
, 2020
1. Bring this form with you to your appointment with your typed statement of special
circumstances and any documentation to support your special circumstances. If you are a
CalWorks, EOPS, DSPS, or Veteran student you are encouraged to meet with your program
Counselor.
2. Include a copy of your Student Education Plan.
3. If you are requesting a petition for Academic/Progress probation due to extenuating circumstances
such as verified illness, accident or circumstances beyond your control, or documented changes in
your economic situation, please include a copy of supporting documents. (Examples of
supporting documentation are doctors notes, accident report, loss of job, etc.)
4.
Submit the completed petition form to the Financial Aid Office with the required and supporting
documentation based on you
r petition re
ason. Any missing information will result in your
Enrollment Priority/CCPG Petition form being denied by the CCPG Petition Committee.
5. Include a copy of your Peralta unnoficial academic transcript.
6. Complete a current year FAFSA, Dream Act application (for AB540 students) or a paper CCPG
application.
Once your CCPG Petition is submitted, a CCPG petition committee will review the completed Petition.
During peak periods (registration periods) there may be an extended longer wait time for the Petitions
Committee decision. The decision of the committee is final and cannot be contested.
*If you are Foster Youth under the age of 24, you are exempted from the petition process. Please contact the
Admissions Office and/or the Financial Aid Office for more information.
Rev. 3/15/2019 KT
Peralta Community College
District Student Services
Student Information
Berkeley City College
College of Alameda
Laney
College
Merritt College
Home College: Alameda Berkeley City Laney Merritt
Name:
Last First Middle Student ID
Address:
Street
City State Zip code
Email Phone
Semester: Fall Spring Summer Academic Year:
Are you currently in one these programs?
CalWorks EOPS DSPS Veterans CAFYES Current or former Foster Youth
Have you completed a current year FAFSA or CCPG Application? Yes No
Loss of CCPG (check all boxes that apply):
Academic/Progress Probation Extenuating Circumstances: verified illness, accident or circumstances beyond the control of the
student or other circumstances that might include documented changes in the students economic situation. (Examples of
documentation are doctors notes, accident report, loss of job, etc.)
I have been making significant academic improvement by completing my last semester with a 2.00+ GPA and completed more
than 50% of my semester coursework.
I am a registered DSPS student who applied before the deadline, but did not receive an accommodation in a timely
manner.
(Include with this petition a letter from the DSPS office verifying this information)
I have not enrolled at Peralta for two consecutive semesters (fall/spring) since I became ineligible for my CCPGW Fee waiver.
I declare under penalty of perjury that all information on this form is true and correct. I understand that this petition from is void
should I fail to make academic progress.
Student Signature:
Date:
I have attached a copy of my Comprehensive Student Education Plan (SEP), a typed statement, copy of your Peralta
unnoficial academic transcript, and any additional documents to support my special circumstances.
Office Use Only
College: Alameda ____ Berkeley ____ Laney ____ Merritt_____
Committee Recommendation: Approved ______ Denied ______ Pending ______ Review Date: ________________
Manager or Committee Chair Signature_______________________________________________ Date: ________________
Comments: ____________________________________________________________________________________________
Rev. 3/15/2019 KT
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