This appeal is not a financial aid application. Make sure you file a current year FAFSA.

TITLE IV SATISFACTORY ACADEMIC PROGRESS APPEAL

STEPS TO FILE A TITLE IV APPEAL

Allow a minimum of two weeks to complete this appeal, keeping in mind that you must meet with an academic
advisor and a counselor, write a personal statement, and gather documentation to complete the appeal.

1. Complete Sections 1 and 2 of this form.

2. Reach out to your assigned academic advisor and let them know that you would like to file a Title IV Appeal, attach the
form with sections 1-2 completed. If you do not have an assigned advisor, please contact TitleIV@bmcc.cuny.edu, and
be sure to include your full name and EMPLID (student ID) number.
3. Your advisor will meet with you to complete Sections 3 and 4. Together, you will determine the reasons for financial
aid suspension, the semester for which you are appealing for aid and an academic plan that outlines how to meet the
college’s standards of academic progress.
4. Review the plan and the information the advisor filled into section 4 before signing the Student Certification section.
Signing means that you agree to follow the plan.
5. Complete a personal statement (see Section 5) that includes steps for academic success (see Section 6). Please see
the “Helpful Tips for Preparing Your Appeal” prior to writing your statements.
6. Contact the Counseling Center at Appeals@bmcc.cuny.edu to schedule a time to speak with a counselor. Attach the
appeal form with sections 1-4 completed, all documentation (see Section 6) and your personal statement.
7. After the meeting, your counselor will attach their remarks and provide you with the completed form.
8. Review all sections of the form to ensure they have all been completed and signed appropriately. Ensure that you have
attached all available documentation and your personal statement.
9. Submit the form and all attachments to Registrar@bmcc.cuny.edu before the deadline.

DEADLINE

Your appeal must be received by the submission deadline listed on the academic calendar for the current term on the
BMCC website. To submit the appeal by the deadline, you must begin the process by contacting your advisor at least
two weeks before the submission deadline. Aid cannot be reinstated retroactively for a prior term.

SECTION 1: STUDENT INFORMATION

Print Name: 8-digit CUNYfirst ID(EMPLID#):23859827

Last, First
New York NY 11377
Street Address:6019 44th Avenue Apt 2F City: State: Zip:

crosario1400@gmail.com 3472166007
E-mail Address: Telephone Number:

SECTION 2: EXTENUATING CIRCUMSTANCES

Indicate the reason(s) that have caused your academic progress to be unsatisfactory and attach relevant supporting
documentation, such as physician’s statements, hospitalization/treatment records, accident reports, death certificates,
obituary notices, etc.

Personal illness or injury Changing work conditions beyond your control

Death or illness of immediate family member Change of curriculum

Personal crisis or undue hardship Traumatic event or natural disaster

Other (please explain) Work schedule changed and I had no time for school.

1
 Rosario, Carlos Registrar: Give student a time-stamped photocopy
Student Name (Last, First): of this page when the Title IV appeal is submitted.

SECTION 3: REASON FOR FINANCIAL AID SUSPENSION

Please check all that apply:

I have not met the college’s minimum retention standard based on my cumulative GPA and have been
✔ placed on academic probation or special probation.
I have exceeded the maximum credit hour limit (that is, I have attempted more than 150% of the credits
normally required for my degree).
My cumulative rate of completion is below the required pace of progression standard.

SECTION 4: ACADEMIC PLAN

Meet with an Academic Advisor and develop a reasonable and attainable financial aid academic plan outlining the
courses you need to complete your program of study and a timeframe for completion. The plan should cover the
semesters in which you intend to enroll within the current academic year. The emphasis should be on those courses you
need to complete your program of study and further your academic objectives. It is not necessary that you complete your
program within the current academic year as long as substantive progress toward program completion is achieved.

Academic Advisor Certification

2022
This Title IV Appeal is for the Fall Spring Summer __________ semester.
Enter Year

I approve the attached academic plan, which, if followed, will assist the student in reaching program completion and an
academic standing acceptable for BMCC’s graduation requirements.

Andy E. Piña 12/30/2021

Advisor’s Signature Print Advisor’s Name Date

Student Certification

I agree to abide by the terms and conditions of this academic plan as set forth by my Academic Advisor. I confirm that the
semester given above is the semester for which I wish to receive financial aid. I understand that my progress will be
monitored each semester and that failure to comply with these conditions will result in the immediate suspension of my
financial aid awards for the semester covered by this appeal.

Sign below by typing your name and date into the appropriate fields.
Carlos Rosario 12/30/2021

Student’s Signature Date

2
Student Name (Last, First):

The Counseling Center has prepared these guidelines to help you complete your appeal. We know this can be a
challenging process and encourage you to take your time to prepare a strong case for your appeal. Following
these instructions will make this process easier and SAVE YOU TIME.

HELPFUL TIPS FOR PREPARING YOUR APPEAL

For Personal Statement: A Personal Statement should include (be sure to answer Sections 5 & 6):
What happened in your life during the semester(s) that affected your grades/attendance?
How have these circumstances changed or improved so that they will no longer affect your studies?
What will you do differently to improve your academics in the future? What resources are you going to use?
Examples include personal or immediate family illness (medical, psychological), legal, employment changes, death of an
immediate family member, academic factors, etc.
For Documents: DOCUMENTATION IS REQUIRED and is evidence/proof of life circumstance(s) beyond your control
that you described in your personal statement. Examples include (but are not limited to):
a) healthcare provider statements, proof of illness/injury, accident reports, death certificate, obituary, legal notices,
proof of employment-related issues (e.g., letter from employer, pay stubs showing changes in hours), letters from
community/religious leaders who know your situation.
b) Letters that are submitted as documentation should be official, on letterhead/stationery, and have a signature.
c) Document dates should match the time period described in your personal statement.
Meeting with Counselor: This is an opportunity to discuss issues related to your academic success. To best use this
time, before the meeting you should have submitted your completed appeal form, your statement, and copies of your
documents to appeals@bmcc.cuny.edu

SECTION 5: STUDENT’S PERSONAL STATEMENT

Explain in detail how the factors or circumstances you checked in Section 2 affected your academic performance or
contributed to your withdrawing from or not completing your classes. Make sure to address each semester that you did not meet
minimum standards. [Attach additional sheets, if needed.]
How the change of my schedule at work affected my acedemic performance for this past semester
is I was working a lot these past couple of months and covering many shifts which made me lose
focus to school and completing my school work. Due to the pandemic we were short staffed
and I had to work over time because of this. Some days I would come home from work exhausted
and save my school work for later.

3
 Student Name (Last, First):

SECTION 6: STEPS FOR FUTURE ACADEMIC SUCCESS

Explain the changes you have made in your personal situation to ensure future academic success. Outline the specific steps
you have taken to overcome any obstacles you previously faced that kept you from attaining your academic objectives. Attach
evidence from individuals aware of your circumstances, if applicable (e.g., your employer, physician, psychologist, social
worker, tutor, academic advisor, counselor, etc.)
The changes I have made so that this doesnt happen again is I changed my schedule, and made sure
my job does not interfere with my classes. I will also make sure to manage my time better and make sure
to get all my school work done. I am also planning on going to tutoring at least twice a week so I dont
fall behind.

STUDENT LIFE COUNSELOR’S REMARKS

Student Life Counselor’s Signature Print Name Date

4
Counseling Center, S343 Borough of Manhattan Community College 199 Chambers Street
The City University of New York New York, NY 10007-1097
www.bmcc.cuny.edu tel. 212-220-8140
fax 212-220-1283

January 6, 2022

Committee on Academic Standing

Carlos Rosario/23859827

Title IV

I support this request for financial aid. Mr. Rosario and I have discussed the
academic challenges that he faces. His Academic Advisor recommend B- grades in
his Spring 2022 courses: COM240, COM245, ENG101, MAR100. His cumulative
GPA: COM: 24/15= 1.600. Mr. Rosario states that his inability to manage the
requirements of work and college courses led to his poor performance. He states
that he will adjust his work hours to give him time to attend and prepare for
classes. I have encouraged him to reach out for help as needed from the
Counseling Center, Tutoring, Peer Mentoring, etc.

If his best effort does not raise his cumulative GPA to good standing, he could
make a new start at another college and transfer credits that he has earned at
BMCC. I trust that we can give him an opportunity to prove himself.

With care,

Precious Sellars-Mulhern, Ph.D.

Associate Professor – Department of Student Life
Counseling Psychologist – Cognitive Behavioral Therapist/Coach
212-220-8147, 8140 (secretary)
FAX: 212-220-1283
BMCC Remote Semester Schedule: M & T 9-5, W 10-6 [campus], TH 11-7
psellarsmulhern@bmcc.cuny.edu
Student Name (Last, First):

Committee On Academic Standing Decision

Approval of this appeal will restore the student’s eligibility for receipt of federal financial assistance for one probationary
semester. Continued eligibility for the remaining term(s) of the academic year will depend on the student successfully
meeting the conditions of his or her financial aid academic plan. The student’s progress will be monitored after the first
term covered in this appeal to ensure all probationary conditions have been and continue to be met.

Appeal Approved Appeal Denied

Comments:

__

Committee Chairperson’s Signature Print Name Date

Academic Plan Compliance Review

[to be completed after student completes the 1st probationary semester]

Yes, this student is successfully meeting the conditions of the academic plan in their appeal.

No, this student is not successfully meeting the conditions of the academic plan in their appeal.

If no, please explain:

__

Reviewer’s Signature Print Name Date

The results of the initial appeal and the subsequent compliance review(s) must be reported to the Office of Financial Aid so
that students whose appeals have been approved and who are successfully meeting the conditions of their academic plan
may continue to receive assistance.
Students who are found not to be in compliance with their academic plan after the initial probationary semester will be
placed once again on financial aid suspension. These students may submit a new appeal form with an updated academic
plan after semester grades are posted. This new appeal would have to be resubmitted to and approved by the Committee
on Academic Standing in order for aid eligibility for the subsequent semester(s) to be restored.

5
 Page 1 of 2

BMCC Undergraduate Record for Advisor Use Only

Name: Carlos Rosario

Student ID: 23859827
Course Description Attempt Earn Grd
Intro to Communication
Student Address: 6019 44th Avenue Apt 2F COM 100 0.00 0.00 W
Studies
Woodside, NY 11377-4957
Req Designation: Flexible Core - Individual and Society

py
Print Date: 01/05/2022
Contact Hours: 3.00
Instructor: Gillian Bonanno
ENG 101 English Composition 3.00 0.00 W
Req Designation: Required Core - English Composition
Contact Hours: 4.00
--------------- Beginning of Undergraduate Record --------------- Course Attributes: English Composition
2019 Spring Term English Composition
Computer Science Major Instructor: David Coiro
Regular (01/25/2019 - 05/22/2019)

Co
MES 152 Intro To Contemporary Media 0.00 0.00 W
Course Description Attempt Earn Grd Req Designation: Flexible Core - Individual and Society
ACR 94 Acad Criti Read I 0.00 0.00 S Writing Intensive Course
Contact Hours: 6.00 Contact Hours: 3.00
Instructor: Amanda Hall Course Attributes: ZERO Textbook Cost
ENG 95 Intensive Writing 0.00 0.00 R Writing Intensive
Contact Hours: 6.00 Instructor: James Sayegh
Course Attributes: Low Textbook Cost PSY 100 Introduction to Psychology 3.00 0.00 W
Writing Exit Course Req Designation: Flexible Core - Scientific World
Instructor: Andrew Levy Contact Hours: 3.00
SPN 107 Intro Spn For Speakers Of Spn 3.00 3.00 B+ Course Attributes: Introduction to Psychology
Req Designation: Flexible Core - World Cultures & Global Issues Introduction to Psychology
Contact Hours: 5.00
ial Instructor: Lawrence Elcock
Instructor: Alejandro Varderi Withdrawal Date: 05/17/2021
Academic Standing Effective 05/31/2019: Good Academic Standing Academic Standing Effective 07/22/2021: Good Academic Standing
Attempt Earn Attempt Earn
Term GPA: 3.300 Term Total: 3.00 3.00 Term GPA: 0.000 Term Total: 6.00 0.00
------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------
2020 Fall Term
fic
2021 Summer Term
Communication Studies Major Communication Studies Major
Regular (08/26/2020 - 12/20/2020) Six Wk 1 (05/27/2021 - 07/08/2021)
Course Description Attempt Earn Grd Course Description Attempt Earn Grd
Intro to Communication PSY 100 Introduction to Psychology 3.00 0.00 F
COM 100 3.00 0.00 NC
Studies Req Designation: Flexible Core - Scientific World
Req Designation: Flexible Core - Individual and Society Contact Hours: 3.00
Contact Hours: 3.00 Course Attributes: Introduction to Psychology
of

Instructor: Janet Douglas-Pryce Introduction to Psychology

ENG 101 English Composition 0.00 0.00 W Instructor: Vernon Smith
Req Designation: Required Core - English Composition Repeated: Include Credit & GPA
Contact Hours: 4.00 Five Wk 2 (07/20/2021 - 08/19/2021)
Course Attributes: English Composition Course Description Attempt Earn Grd
English Composition MAT 161 Quantitative Reasoning 0.00 0.00 W
Instructor: Timothy Keane Req Designation: Required Core - Mathematical&QuantitativeReasoning
Un

Repeated: Averaged - Exclude Credit & Include GPA Contact Hours: 3.00
MES 152 Intro To Contemporary Media 3.00 0.00 NC Instructor: Stephen Featherstonhaugh
Req Designation: Flexible Core - Individual and Society
Contact Hours: 3.00 Attempt Earn
Instructor: Catalin Zidaru Term GPA: 0.000 Term Total: 3.00 0.00
SPE 100 Fund of Public Speaking 3.00 3.00 B- ------------------------------------------------------------------------------------------
Req Designation: Flexible Core - Creative Expression
Contact Hours: 3.00 2021 Fall Term
Instructor: Alvin Eng Communication Studies Major
Regular (08/25/2021 - 12/21/2021)
Academic Standing Effective 01/13/2021: Good Academic Standing
Course Description Attempt Earn Grd
Attempt Earn Intro to Communication
COM 100 3.00 3.00 C
Term GPA: 2.700 Term Total: 9.00 3.00 Studies
------------------------------------------------------------------------------------------ Req Designation: Flexible Core - Individual and Society
Contact Hours: 3.00
2021 Spring Term Course Attributes: ZERO Textbook Cost
Communication Studies Major Instructor: Benjamin Powell
Regular (01/29/2021 - 05/25/2021) ENG 100.5 Intensive English Composition 0.00 0.00 WU
 Page 2 of 2

BMCC Undergraduate Record for Advisor Use Only

Name: Carlos Rosario

Student ID: 23859827
Course Description Attempt Earn Grd
Req Designation: Required Core - English Composition
Contact Hours: 6.00
Instructor: Nancy Derbyshire

py
MES 152 Intro To Contemporary Media 3.00 0.00 F
Req Designation: Flexible Core - Individual and Society
Writing Intensive Course
Contact Hours: 3.00
Course Attributes: Writing Intensive
Instructor: Susan Stratton
Academic Standing Effective 12/29/2021: Academic Probation

Co
Attempt Earn
Term GPA: 1.000 Term Total: 6.00 3.00
------------------------------------------------------------------------------------------

2022 Spring Term

Communication Studies Major
Regular (01/28/2022 - 05/24/2022)
Course Description Attempt Earn Grd
COM 240 Interpersonal Communication 3.00 0.00
Req Designation: Flexible Core - Individual and Society
Contact Hours: 3.00
Instructor: Janet Douglas-Pryce
COM 245 The Mass Media 3.00
ial 0.00
Contact Hours: 3.00
Course Attributes: Low Textbook Cost
Instructor: Naida Zukic
ENG 101 English Composition 3.00 0.00
Req Designation: Required Core - English Composition
Contact Hours: 4.00
Course Attributes: English Composition
fic
English Composition
ZERO Textbook Cost
MAR 100 Introduction to Marketing 3.00 0.00
Contact Hours: 3.00
Course Attributes: ZERO Textbook Cost
Instructor: Ioannis Tournas
Attempt Earn
Term GPA: 0.000 Term Total: 12.00 0.00
of

------------------------------------------------------------------------------------------

------------------------------ Cumulative Totals ------------------------------

Attempt Earn
Cum GPA: 1.600 Cum Total: 39.00 9.00
Transfer Cum GPA: 0.000 Transfer Total: 0.00 0.00
Un

Comb Cum GPA: 1.600 Comb Total: 39.00 9.00

End of BMCC Undergraduate Record for Advisor Use Only