This form is to be completed by the student and submitted to the Dean of Student Services (Sequoia 120). Approval of
appeal does not guarantee a space in the course. Incomplete forms will be denied.
Columbia College
Loss of Priority Registration Appeal Form
Date:
Name
E-MailPhone
ID # W
@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:
I took an assessment test at another college on:
I have completed both math and English courses within the past five years (attach transcripts).
Orientation:
I completed orientation at Columbia College on:
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.
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).
This is my last semester at Columbia and I need specific courses to graduate or transfer.
Over 100 units:
I am enrolled in a high unit major or program (attach Educational Plan).
Extenuating Circumstances:
I am a student with a verified disability who applied before the deadline, but did not receive an
accommodation in a timely manner (attached 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:
Date:
Date:
(attach documentation)
Date:
List specific courses needed:
I have changed my major: Counselor signature required ___________________________________________
Approved Denied
Reason:
Dean's Signature Date:
Counselor Signature
