Peralta Community College District
Admissions and Records
Approval Recommended Denied Recommended __________________________________________________
Signature, Counselor
Approved Denied _______________________________________________________________________
Signature, Vice President of Student Services or Designee
Rev. 5/14 Date/initials student notified: ________________ Date/initials priority entered: ________________
Berkeley City College
College of Alameda
Laney College
Merritt College
Priority Registration Appeal
Only students with 100+ degree-applicable units completed at the Peralta Community College District may appeal
Complete this form; attach supporting documentation and take to a counselor.
Counselor will forward the form to the Office of the Vice President of Student Services for approval.
Vice President’s Office will notify the student and forward the form to Admissions and Records for priority reinstatement.
Allow five (5) days for processing.
Name:
__________________________________________________________________________________________________________
Last First Middle
Address:
__________________________________________________________________________________________________________
Street City State
______________________________________
Student ID or last 4 digits of SSN
_____________________________________
Email
Zip code
____________________
Phone
Semester for which you are requesting priority registration: ______________________________
If the appeal is granted, the appeal does not guarantee enrollment in specific courses. The appeal is term specific and if approved allows
previous priority in group #2 as defined by PCCD AP 5055.
* A copy of your current Student Education Plan (SEP) must be attached
Reason for Appeal:
Extenuating Circumstances: verified illness, accident or circumstances beyond my control. (Documentation must be attached).
Extenuating Circumstances: due to disability. **Form must be completed by a DSPS counselor
Explain: _____________________________________________________________________________________________________
Final semester at PCCD and I need specific courses to graduate or transfer. List the specific course(s) required to complete
graduation or transfer: _________________________________________________________________________________________
The course I need is only offered once per year. List the name of the course: __________________________________________
I must register in a specific course(s) that is part of a required sequence. List the name of the course:
___________________________________________________________________________________________________________
I must register in a specific course that is required for my employment. (Documentation must be attached).
Job Title: _____________________________________ List the name of the course: ______________________________________
Other (list the specific reason & name of course(s): _____________________________________________________________
Write a detailed statement explaining why it is important that you be granted priority registration. You may continue your statement on the
reverse side of this form, or add additional paper if necessary. Do not leave blank.
_____________________________________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
