Appeal for Readmission

Please fill in a valid value for all required fields

Please ensure all values are in a proper format.

Are you sure you want to leave this form and resume later?

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

You must upload one of the following file types for the selected field:

There was an error displaying the form. Please copy and paste the embed code again.

There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.

Appeal for Readmission

A student who has been dismissed may submit an appeal for readmission explaining extenuating circumstances that affected their academic performance. Please note that readmitted students must submit a new appeal each semester until their GPA rises to a minimum 2.0 and unit completion rate rises to a minimum of 50%.

Prepare your Appeal

If you are returning to Mission College after more than 1 year of absence, complete the CCC Apply https://missioncollege.edu/admissions/apply.html in order to register for classes.
If available, attach supporting documentation of extenuating circumstances to this appeal. Examples include illness, family emergency, job transfer, immigration action, etc.
Connect with a Counselor to review the classes you wish to take and set up time a to create an updated education plan before the next registration cycle. A counselor's comments are needed to complete this appeal.
Questions? Contact the A&R Office at (408) 855-5000 & mc.studentpetitions@missioncollege.edu

STUDENT INFORMATION

Legal Name*

First Name

Middle Name (optional)

Last Name

Mission College ID*

WVM or personal email address.*

A Photo ID is required to process this request*

No File Chosen

File uploads may not work on some mobile devices.

Acceptable IDs: High school or College ID Government issued ID (CA ID, CA Driver's License, passport, Employment Authorization Cards) Government issued ID from another country

My dismissal status is*

Academic Dismissal (Cumulative grade point average is less than 2.00 for each of three consecutive semesters) Progress Dismissal (Total percentage of ‘W,’ ‘I’ and ‘NC’ grades reaches or exceeds fifty percent (50%) of the total units attempted for three consecutive semesters)

Please list the semester you are requesting readmission and enrollment:*

Financial Aid

I am currently receiving Financial Aid and understand that changes to my record may require repayment of funds I have received. *

YES NO

Please contact the Financial Aid Office if you have any questions at mcfa@missioncollege.edu

Supporting Material

Describe what events took place impacting your academic performance. (Check all that apply.)*

Health (birth, medical, injury, accident) Life changes (death of a loved one, divorce, financial concerns) Employment (loss of job, new job, change in work hours) Gaps in college enrollment Other (explain below)

Based upon the boxes checked above, explain in greater detail what happened and your plans to improve your academic performance. Attach any pertinent supporting documentation. *

Upload Supporting Documentation

No File Chosen

File uploads may not work on some mobile devices.

Do you have a current Ed Plan you are following?*

YES NO

Your Counselor's Name*

Your Counselor's Email (if you do not have a counselor please select alicia.martinez@missioncollege.edu)*

Course Information*

I am unsure of what courses to take at this time. I know which courses to take at this time.

Please list the courses you are requesting to enroll in:

1. Course & No *

example: BIO 010

5- Digit CRN*

example: 35726

Units*

Add Another Course*

Yes No

2. Course & No

example: BIO 010

5- Digit CRN

example: 35726

Units

Add Another Course #2*

Yes No

3. Course & No

example: BIO 010

Units

5- Digit CRN

example: 35726

Add Another Course #3*

Yes No

4. Course & No

example: BIO 010

5- Digit CRN

example: 35726

Units

Signatures & Authorization

By submitting this form, I declare under penalty of perjury that the statements and information submitted on this form are true and correct. I understand that all materials submitted by me for the purposes of maintaining my record become the property of the West Valley-Mission Community College District.

Student Name (type your name to confirm agreement to these terms.)*

Comments or Questions:

Counselor Comments

A Current Ed Plan has been completed.*

YES NO

Counselor Comments*

You can copy and paste from an email or attach a document below.

Upload Counselor Comments (if additional space needed)

No File Chosen

File uploads may not work on some mobile devices.

Counselor agrees with courses the student has listed.*

YES NO

Counselor Name*

Recommended Schedule

1. Course & No

example: BIO 010

5- Digit CRN

example: 35726

Units

Add Another Course

Yes No

2. Course & No

example: BIO 010

5- Digit CRN

example: 35726

Units

Add Another Course

Yes No

3. Course & No

example: BIO 010

Units

5- Digit CRN

example: 35726

Add Another Course

Yes No

4. Course & No

example: BIO 010

5- Digit CRN

example: 35726

Units