For Customer Service
If Covid-19 is the basis of your appeal, no fee is required. Please indicate this in your appeal statement.
Applicant Name: ______________________________________ Student ID: __________________________________
Personal Email: _______________________________________ Address: ________________________________________
Level of Study: Freshmen OR Transfer Term: Fall 20 ___ Spring 20 ___ Summer 20 ___
Submit all documents in one complete packet. Only complete appeals will be accepted.
Please read all appeal instructions and criteria before submitting your appeal packet at:
1. Include this Appeal Cover sheet.
2. Provide a brief written statement that clearly and concisely states the reason for the appeal.
3. Provide official or unofficial transcripts and/or test scores, if applicable.
4. Include all supporting documentation with your appeal, (e.g., proof of mailing/submissions of requested
information, medical//legal documentation), if applicable.
Indicate Reason for the Appeal:
Missed Deadline Admissions Decision
Transcript Deadline
Intent to Enroll Deadline
Application Deadline: Processing $15 fee required
(Check or money order must be attached with appeal
The following applies to all types of appeals:
Letters of Recommendation will not be considered.
Only one appeal may be submitted per semester, appeal decisions are final.
Documents submitted as part of the appeal will not be returned to the applicant.
Appeal decision will be mailed within two weeks of submission and will be reflected on your
Campus Account at
Submit your complete Admissions Appeal packet to:
Office of Admissions and Records
Attn: Undergraduate Admissions Appeal Committee
CSU Dominguez Hills
1000 East Victoria Street, WH C290
Carson, CA 90747
I certify that I have read the Admissions Appeal information on the CSUDH website and have submitted a complete packet.
Applicant Signature: ______________________________Phone: (_______) _________________ Date: _______________
Reviewed By: Date: Current Status:
Appeal Type: Appeal Status: Approved: Denied:
Student Group(s): Holds: Evaluated By:
Appeal Action: ADMT: DENY: Date:
Request for Re-Evaluation of Denied or Revoked Admission
Request for Intent to Enroll Fee Waiver (COVID-19)
Other Reason (Include documentation):