Academic/Progress Dismissal Appeal

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Counselor's Name:* This field is required.Please indicate the name of the counselor you have an scheduled an appointment with
First Name
Last Name
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Counselor's Email: * This field is required.Please provide your Counselor's Delta College email. A copy of your appeal & supporting documentation will be forwarded to the indicated counselor once you submit your appeal.
example@example.com
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Name* This field is required.Please indicate your first and last name
First Name
Last Name
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Student ID* This field is required.Please indicate your student ID number (Example: 1000101010)
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Student Email* This field is required.Please indicate your San Joaquin Delta campus email
jsmith123@mustangs.deltacollege.edu
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IMPORTANT INFORMATION TO ACKNOWLEDGE: You may appeal your dismissal status if you have additional information that warrants an exception to the dismissal action. It is your responsibility to provide a personal statement that details the grounds for which continued enrollment should be granted and to include supporting documentation for the exception request. You will be asked to upload your written statement and supporting documentation.

You will remain on dismissal status while the appeal petition is being reviewed and in progress. A decision regarding the appeal will be communicated to your college email within 15 business days of receipt of the appeal petition request.

Dismissal appeals may be granted under the following circumstances:
1. If the grades resulting in dismissal are not reflective of the student’s usual academic performance.
2. If the dismissal occurred as a result of an extenuating circumstance beyond the student’s control that resulted in the causation of the dismissal status (i.e., hospitalization, serious illness, other extenuating circumstances beyond the student’s control). Supporting documentation must be attached to this appeal.
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I am completing my Dismissal Appeal for the following:* This field is required.Select from the drop down menu below
Academic Dismissal
Please Select
Academic Dismissal
Progress Dismissal
Both Academic and Progress Dismissal
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Please upload your personal statement detailing your extenuating circumstance:* This field is required.
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Max. file size: 10.6MB
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Please upload your supporting documentation or evidence.:* This field is required.
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Max. file size: 10.6MB
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Signature* This field is required.By signing below, I understand and acknowledge the conditions by which my appeal may be granted and I will adhere to all conditions set forth by the outlined agreement.
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