Academic Progress Appeal Form

STUDENT INFORMATION

 *

STUDENT INFORMATION

BMCC ID	First Name	Last Name
Email address	Phone Numberext.

Success Coach/Center Director

 *

Success Coach/Center Director(Select an Answer) Ann Mortar Annie Smith Ashley Masterson-Armichardy Jennifer Hills Jennifer Utroska-Robles Joey GrosJacques Jordan Hillmick Marcy Knopf Shelly Mack Sonya DeLatorre Susan Kralman Nayeli Ruiz Jessie Howard

Certificate/Degree Intent

 *

Certificate/Degree Intent(Select an Answer) AAOT - Associate of Arts-Oregon Transfer AGS - Associate of General Studies Accounting Technology (AAS) AS - Associate of Science ASOT\BUS - Associate of Science Oregon Transfer\Business ASOT\CS- Associate of Science Oregon Transfer\Computer Science Administrative Office Professional (AAS) Administrative Office Professional: Legal (AAS) Administrative Office Professional: Medical (AAS) Administrative Office Professional: Office Assistant (Cert) Agriculture: Business (AAS) Agriculture: Production (AAS) Agriculture: Production: Crops (AAS) Agriculture: Production: Livestock (AAS) Business Administration (AAS) Business Administration Hospitality and Gaming (AAS) Business Administration: Hospitality & Gaming: Hospitality, Tourism, and Management (Cert) Business Administration: Leadership and Service (AAS) Business Administration: Leadership and Service: Customer Service in the Public Sector (Cert) Business Administration: Leadership and Service: Leadership in the Public Sector (Cert) Business Administration: Web Development Option (AAS) Construction Trades, General Apprenticeship (AAS) Construction Trades, General Apprenticeship - Construction Trades General Apprenticeship (Cert) Criminal Justice (AAS) Data Center Technician (Cert) Diesel Technician (AAS) Early Childhood Education Electrician Apprenticeship Technologies Emergency Medical Technician Fire Science Technology Industrial Mechanics & Maintenance Technology Apprenticeship Mechatronics/Industrial Automation Technology Nursing Paraeducator Precision Irrigated Agriculture Retail Management Veterinary Assistant

STUDENT WRITTEN STATEMENT: Academic Challenges

Indicate below what extenuating circumstances happened during the last two (2) terms that have not met the cumulative GPA of at least 2.0 and/or cumulative Pace (credit completion rate) of at least 67%, that prevented you from successfully completing some or all of your courses.   Examples of extenuating circumstances include situations that can be documented; OR are unforeseen; OR beyond your control; OR occurred during the term; OR had a direct impact on your ability to successfully complete each term.

Note: Lack of financial aid by the end of the add/drop period is not considered "unforeseen" and does NOT meet the criteria for appeal.

 *

STUDENT WRITTEN STATEMENT: Academic Challenges Indicate below what extenuating circumstances happened during the last two (2) terms that have not met the cumulative GPA of at least 2.0 and/or cumulative Pace (credit completion rate) of at least 67%, that prevented you from successfully completing some or all of your courses. Examples of extenuating circumstances include situations that can be documented; OR are unforeseen; OR beyond your control; OR occurred during the term; OR had a direct impact on your ability to successfully complete each term. Note: Lack of financial aid by the end of the add/drop period is not considered "unforeseen" and does NOT meet the criteria for appeal.

Plan for Success (Student to complete) : Provide a written statement that explains how you have resolved the situation/s that caused you to be unsuccessful in the past.  Be sure to include the steps or actions you will take to ensure future successful completion such as tutoring, reduced course load or work hours.

 

 

 *

Plan for Success (Student to complete) : Provide a written statement that explains how you have resolved the situation/s that caused you to be unsuccessful in the past. Be sure to include the steps or actions you will take to ensure future successful completion such as tutoring, reduced course load or work hours.

Success Coach Supporting Statement (Your Success Coach must complete this section.

 *

Success Coach Supporting Statement (Your Success Coach must complete this section.

Success Coach: Recommended Course Load (Your Success Coach must complete this section)

 *

Success Coach: Recommended Course Load (Your Success Coach must complete this section)

Full Time (12 or more credits)

Three-quarter time (9 - 11 credits)

Half-time (6 - 8 credits)

Less than half-time (1-5 credits)

Other

Success Coach: Recommended Course Format (Your Success Coach must complete this section)

 *

Success Coach: Recommended Course Format (Your Success Coach must complete this section)

Online

Face-to-face (on campus)

Online and face-to-face

Success Coach - Additional Supports Discussed with Student

Your Success Coach must complete this section and will mark all that apply.

Success Coach - Additional Supports Discussed with Student Your Success Coach must complete this section and will mark all that apply.

Tutoring	Transportation needs
Other	Periodic meetings with Success Coach
Disability Services

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

Page 1 / 1