This form is to be completed by the student and submitted to the Vice President of Student Services
(Manzanita 275). Approval of appeal does not guarantee a space in the course. Incomplete forms will be
denied.
Columbia College Loss of Priority Registration Appeal Form
Student ID# Name Date
Phone Number Email
@student.yosemite.edu
Semester for Appeal Educational Goal (s)
I am requesting reinstatement of my loss of priority registration for the following reason(s):
Assessment:
I took the assessment test at Columbia College on:
Date
I took the assessment test at another college on:
Date
(Attach Documentation)
I have completed both math and English courses within
the past five years (attach transcripts).
Orientation:
I completed orientation at Columbia College on:
Date
I have completed an Associate degree or higher (attach
transcript)
Educational Plan:
I have completed an Educational Plan at Columbia
College (attach Educational Plan)
Academic Standing:
I have demonstrated significant academic improvement
Counselor Signature:
Students who lose priority enrollment due to academic or progress disqualification must
demonstrate significant academic improvement by successful completion of at least one
semester with at least a 2.0 GPA AND counselor approval. The work may be at Columbia
or another institution. (Include transcripts if work was completed at another institution).
Over 100 Units:
This is my last semester at Columbia and I need specific
courses to graduate or transfer.
List specific
courses needed:
I am enrolled in a high unit major or program (attach
Educational Plan)
I have changed my major: (Counselor Signature Req.)
Counselor Signature:
Extenuating Circumstances:
I am a student with a verified disability who applied
before the deadline, bud did not receive an
accommodation in a timely manner (attach
documentation from DSPS)
I have an extenuating circumstance based on verified
illness, accident or circumstance beyond my control
(attach an explanation of the circumstance and/or
appropriate documentation).
Student Signature:
Date
Approved Denied
Reason:
Dean's Signature:
Date
Priority Level:
4 3 2 1
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