OFFICE USE ONLY DATE RECEIVED:

ROUTING:

TO DEPARTMENT CHAIR/COUNSELING
Date
COLLEGE NOW! APPEAL FORM Date
TO DEAN, STUDENT SERVICES

TO TESTING CENTER
Date

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 Eligibility
G.P.A.

If approved College Now! students may take up to a maximum of 6 units, in summer, fall, and spring
semesters and winter intersession. Students interested in taking courses on List A are now
required to go through START at Allan Hancock College only – the test is not available by
proctor.

Ticket # ____________ Course Title: Units

Ticket # ____________ Course Title: Units

Ticket # ____________ Course Title: Units

High School Administrator’s Signature:

Parent Signature:
Student Signature:

Appeal Procedure: If you feel that any matriculation procedure or service is being applied in a discriminatory
manner, an appeal may be filed. On the reverse side of this form, please write a one page descriptive
statement, which includes the following:

1. Have you explored all options available at your local school districts?
2. Attach any pertinent documentation to support your request as to why you wish to take a course(s) at
Allan Hancock College
3. Include a letter of recommendation from an Administrator, Principal or Counselor.
4. 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 and
Matriculation, Building A, 800 So. College Drive, Santa Maria, CA 93454.
 Upon filing the appeal, you may take the START test at Allan Hancock College to determine eligibility of course
listings A. The appeal review process takes up to 7 – 10 working days.

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.

Student Name: SS#

STUDENT STATEMENT / REQUEST: