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COLLEGE NOW! APPEAL FORM

Name: Date Submitted:Address: Telephone:City/State/Zip: SSN:

MATRICULATION PROCEDURE OR SERVICE BEING APPEALED: Check the option that applies to you.Excess Units (If approved total units requested? _________)Freshman/Sophomore EligibilityG.P.A.

If approved College Now!

students may take up to a maximum of

6 units

, in summer, fall, and springsemesters and winter intersession

Students interested in taking courses on List A are nowrequired to go through START at Allan Hancock College only

– the test is not available byproctor.

Ticket # ____________Course Title: UnitsTicket # ____________Course Title: UnitsTicket # ____________Course Title: UnitsHigh School Administrator’s Signature:Parent Signature:Student Signature:

Appeal Procedure: If you feel that any matriculation procedure or service is being applied in a discriminatorymanner, an appeal may be filed. On the reverse side of this form, please write a one page descriptivestatement, which includes the following:1.Have you explored all options available at your local school districts?

Attach any pertinent documentation to support your request as to why you wish to take a course(s) atAllan Hancock College3.Include a letter of recommendation from an Administrator, Principal or Counselor.

Attach a copy of your high school transcript and/or AHC Student profile.5.Submit the completed appeal and any documentation to the office of the Dean, Counseling andMatriculation, Building A, 800 So. College Drive, Santa Maria, CA 93454.

OFFICE USE ONLY

DATE RECEIVED:

ROUTING

:TO DEPARTMENT CHAIR/COUNSELINGDateTO DEAN, STUDENT SERVICESDateTO TESTING CENTERDate

Upon filing the appeal, you may take the START test at Allan Hancock College to determine eligibility of courselistings A. The appeal review process takes up to 7 – 10 working days.

Student Name: SS#

STUDENT STATEMENT / REQUEST:

Disposition of Appeal - For Official Use Only

Recommend appeal be approved. Recommend appeal be denied.Comments:Department Chair, Counseling: Date:

Office of the Dean – Action Taken:Approved _____Denied _____

Comments:

Dean, Matriculation and Counseling Date:

Nondiscrimination Statement:

The Allan Hancock Joint Community College District is committed to the active promotion of diversity and equal access and opportunities to all staff,students, and applicants, including qualified members of underrepresented/protected groups. The college assures that no person shall be discriminated against regardless of race,color, ancestry, religion, gender, national origin, age, physical/mental disability, medical condition, status as a Vietnam-era veteran, marital status, or sexual orientation.