Admissions & Recruitment
Sage Hall 1020
One University Drive
Camarillo CA 93012
Name: Dolphin ID#:
Term of Application:
Fall or
Email: Contact Number:
Current School Attending:
1. Attach a typed statement that explains your reason for appealing. The personal statement must be
completed by the applicant. In order for us to best understand the nature of your appeal, please use
proper grammar and punctuation.
2. Include documentation to verify any claims made in your statement regarding hardship, illness, or other
extenuating circumstances. A personal statement does not constitute documentation. Letters of
recommendation will not be considered. IMPORTANT: Documentation related to sensitive personal or
medical issues should be the minimum necessary to understand your hardship, illness, or other
extenuating circumstance. Documentation will NOT be returned, so please do NOT submit original
3. If our letter states that your admission was denied due to not being CSU eligible or that your admission
was rescinded or cancelled for not having met admission requirements, then the following documents
must be received by CSUCI within 15-business days of the date on your Denial or Rescind Notice in
order for your appeal to be considered:
o Official transcripts from all colleges and universities attended even if (a) no credit was
earned and/or (b) course credit is reflected on another school’s transcript. If you have
taken coursework from an institution outside of the United States, your transcript must be
evaluated by a credentials evaluation services, such as International Education Research
Foundation (IERF) at A detailed report with course level identification from
the credential evaluations service must be included as part of your appeal package.
o A receipt showing that your transcript was ordered. NOTE: All transcripts must be
received within the 15-business days referenced above.
o Official Advanced Placement (AP) examination scores and/or International Baccalaureate
(IB) transcripts (if applicable). NOTE: If you are unable to obtain AP or IB scores within the
required 15-business days, then you must submit written proof that you have ordered the
scores AND include an unofficial copy of your test scores.
o Military documents if applicable (DD214, Joint Services Transcripts (JST), Community
College of the Air Force transcript).
4. For individuals with disabilities must provide supporting documentation and historical verification of their
disability. CI will evaluate disability documentation using guidelines established by the California State
University (CSU) system. All appeals are reviewed on a case-by-case basis. IMPORTANT:
Documentation will NOT be used to determine accommodations if your appeal is successful. Students
must contact Disability Accommodation and Support Services (DASS) to request services.
Documentation provided as part of your appeal packet will NOT be shared with DASS but will be
treated in a professional and confidential manner.
5. If you missed the deadline for submitting final official transcripts and/or official AP test scores, you
must submit a Request for an Admissions Appeal within 15-business days from the deadline noted
in the Admissions Rescind Letter/email. Failure to adhere to deadlines is not likely to be viewed
favorably by the Admissions Appeal Committee. Students are responsible for complying with all
deadlines and instructions included in the Enrollment Guide.
6. If you were not accepted to the Nursing Program, please note that decisions made by the Nursing
Program cannot be appealed. However, if you would like for your admissions to be reconsidered
under an alternate major, please indicate an alternate major below. Your application will be
reevaluated to determine your CSU eligibility under your alternate major. Please review my
application for CSU Eligibility under my Alternative Major: ________________________.
Mail (fax and email NOT accepted) this form and supporting documentation to:
Admissions Office
RE: Admissions Appeal
CSU Channel Islands
Sage Hall 1020
One University Drive
Camarillo, CA 93012-8599
We strongly advise you to mail your completed appeal packet via priority mail or another
source where you can track its delivery. Due to the high number of appeals we receive, we are
unable to confirm receipt of your package.
If you are determined to be admissible, you will receive a letter in the mail offering you admission. If your
appeal is not successful, then you will receive an email notifying you of the outcome. Please allow 4
weeks for processing.
I have read the Admissions Appeals Process and above instructions and understand that I must submit all
documentation by the stipulated deadline or my packet will be considered incomplete. I further understand that
incomplete packets will be automatically denied and no further appeals will be allowed.
Signature Date
Date Reviewed:
Referred to Committee on:
Notes for Committee:
Date Reviewed by
Appeal Granted by Committee
Appeal Denied by Committee
Date Notification Sent:
Notification sent by:
Date PeopleSoft updated:
Admission Basis Code/Exception Reason:
click to sign
click to edit