Loss of Enrollment Priority and/or CCPG Fee Waiver Appeal
This form is to appeal your enrollment priority and/or loss of CCPG Fee Waiver
Note: Per state regulations, Foster Youth and Former Foster Youth (up to age 24) are exempt from loss of both priority registration and/or CCPG fee waiver
Please use dark ink.
Please check one box:
I am requesting: Priority Registration Reinstatement of the CCPG fee waiver Both Priority Registration and CCPG
Student’s Full Name: _____________________________ _____________________________ ______
Last Name First Name MI
AHC Student ID Number: H ____________________________ Phone: ________________________________
AHC Email Address:
email@example.com Semester for Appeal____________
Reason for Appeal (check one):
Extenuating Circumstance: Academic/Progress Probation Extenuating Circumstances: verified illness, accident or circumstance
beyond the student’s control. Provide supporting documents such as doctor’s notes, accident report, etc. You must attach a typed
explanation of how your situation affected your ability to meet academic standards.
Extenuating circumstances may also include special consideration for students who are currently in one of these programs (check all
that apply and take this form to your respective program for review.) CalWORKs EOPS LAP Veterans
Significant Academic Improvement: I have been making significant academic improvement by completing my last semester with a
2.00+ GPA and completing more than 50% of my semester coursework.
Most recent completed semester: GPA: Unit completion (percentage):
Verified Disability: Contact Learning Assistance Program (LAP) for an appointment with a counselor or specialist to review your
request for an appeal for priority registration or loss of CCPG. You must attach a letter of verification signed by that AHC LAP faculty
Enrollment in courses required for a high unit major or program: High unit majors and programs include, but are not limited to,
Science, Technology, Engineering, and Mathematics fields. You must attach a Comprehensive Educational Plan detailing one of
these high unit programs.
Support Services: I was unable to obtain essential support services such as orientation, assessment and counseling. You must
provide a typed-written statement explaining which specific support service you were referred to and why you were unable to
Not enrolled at Allan Hancock College: I have not enrolled at Allan Hancock College for two consecutive semesters, excluding
summer, since I became ineligible for my CCPG Fee waiver.
LAST PRIMARY SEMESTER ATTENDED:
I declare under penalty of perjury that all information on this form is true and correct. I understand that this appeal form is void
should I fail to make academic progress.
Student Signature (mandatory): ________________________________ Date: _______________
The student must complete the check list on the reverse side of this form.
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