Petition to Appeal Loss of Enrollment Priority and/or Loss of California College Promise Grant Fee Waiver (Formerly known as BOG)

This form is to appeal your enrollment priority loss and/or loss of CCPG Fee Waiver.
*Note: Foster Youth and Former Foster Youth (up to age 25) are exempt from loss of both priority registration and CCPG Fee Waiver per regulation.

1Petition to Appeal Loss of Enrollment Priority and/or Loss of California College Promise Grant Fee Waiver (Formerly known as BOG) > 2Form Survey
READ THIS BOX CAREFULLY BEFORE COMPLETING THIS FORM.
1. LOSS OF PRIORITY REGISTRATION: Per Title 5, Section 58108 Regulations of the California Community College System, your calculated academic standing will impact your assigned registration date for future semesters. A second consecutive term (fall/spring semesters) on academic or progress probation will result in the loss of continuing student priority registration. This will also apply to any student over 90-unit limit (excluding non-degree applicable and ESL courses). This means you would register after all continuing and new students thereby possibly losing your opportunity for the courses you need to meet your educational goal. 2. LOSS OF CALIFORNIA COLLEGE PROMISE GRANT FEE WAIVER (CCPGFW): Please be aware a student that continues on a second consecutive term (fall/spring semesters) on academic or progress probation will result in the loss of the CCPG Fee Waiver until you are no longer on probation. 1. Complete the student information part of this appeal form and a typed narrative of your situation to the counseling department to schedule an appointment only if you need a Comprehensive Educational Plan or need Counselor Verification regarding special consideration that you are requesting. (If you are Foster Youth you are exempted from this process. Please contact the Admissions Office.) When making an appointment with a counselor, let the scheduler know you are requesting an appeal and will need a comprehensive education plan or will be updating your current education plan. 2. Bring this form with you to your appointment with your typed narrative and supporting documentation. If you are a CalWorks, EOPS, DSPS, or Veteran student you must meet with the appropriate program Counselor. Your counselor will complete as appropriate the Program Verification Form to be submitted with your appeal. 3. If you are requesting an appeal for Academic/Progress probation due to Extenuating Circumstances such as verified cases of accidents, illnesses, or other circumstances beyond your control, or documented changes in your economic situation have your supporting documentation ready. (Supporting documentation are doctor’s notes, accident report, loss of job, etc.) 4. Submit the completed Appeal form to Admissions & Records with all of the supporting documentation that is indicated on the form based on your appeal reason (Appeal Form, typed narrative, comprehensive education plan, and supporting documentation). Any missing information will result in your Enrollment Priority/CCPG Fee Waiver Appeal form being rejected by the Appeals Committee. All Appeal forms and documentation must be received by Admissions & Records Department by the established College deadline date noted above (for Enrollment Priority Appeals only). Planning ahead is very important!
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Please select: I have read and understand the information above.
Full Name: Full Name: First Middle Last
Student ID# G00:
IVC Email:
Contact Number: Contact Number: - ### - ### ####
Course of Study/Major:
Term/Year Applying For:
Date: Date: / MM / DD YYYY
Minimum documents that must be included with this form as well as those identified below:
A Typed narrative of your situation AND a copy of a current Comprehensive Educational Plan (DegreeWorks link: http://my.imperial.edu/degreeworks)

Attach Files
Enrollment Priority Appeal Reasons: (check if applicable)
Academic/Progress Probation Extenuating Circumstances: verified cases of accidents, illnesses, or other circumstances beyond the student’s control. (Examples of documentation are doctor’s notes, accident report, etc.) I am a student with a verified disability who applied before the deadline for but did not receive an accommodation in a timely manner or Enrollment Priority is a verified accommodation (DSPS documentation required). I have earned 90 or more degree applicable units at IVC and I am enrolled in a high unit program.
Loss of CCPG Fee Waiver:(check one if applicable: California College Promise Grant recipients only)
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1. Academic/Progress Probation Extenuating Circumstances: verified cases of accidents, illnesses, or other circumstances beyond the student’s control or other circumstances that might include documented changes in the student’s economic situation. (Examples of documentation are doctor’s notes, accident report, loss of job,etc.)
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Upload written statement if selected option 3.

Attach Files
4.

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Check all that apply if selected option 4:

Check all that apply if selected option 4: CalWorks EOPS DSPS Veterans
Student Signature:

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I declare under penalty of perjury that all information on this form is true and correct. I understand that this appeal form is void should I fail to make academic progress.
I understand this is a legal representation of my signature.
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Full Name

I declare under penalty of perjury that all information on this form is true and correct. I understand that this appeal form is void should I fail to make academic progress.
I understand this is a legal representation of my signature.
Use mouse to sign.
Upload your IVC Student ID or a Valid ID for verification:

Attach Files
A&R OFFICE USE ONLY
Committee Review Date: Committee Review Date: / MM / DD YYYY
Committee Recommendation:

Committee Recommendation: Approved Denied Semester GPA Comulative GPA
Support Services/Follow up Recommended:
Petition Committee Chair Signature:

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I understand this is a legal representation of my signature.
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Full Name

I understand this is a legal representation of my signature.
Use mouse to sign.

Petition to Appeal Loss of Enrollment Priority and/or Loss of California College Promise Grant Fee Waiver (Formerly known as BOG)

Petition to Appeal Loss of Enrollment Priority and/or Loss of California College Promise Grant Fee Waiver (Formerly known as BOG)

Minimum documents that must be included with this form as well as those identified below:

Enrollment Priority Appeal Reasons: (check if applicable)

Loss of CCPG Fee Waiver:(check one if applicable: California College Promise Grant recipients only)

A&R OFFICE USE ONLY