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Appendix A CSAC APPEAL CERTIFICATION FORM

5 CA ADC Div. 4 Ch. 1 Art. 4.5 App. ABarclays Official California Code of Regulations

Barclays California Code of Regulations
Title 5. Education
Division 4. California Student Aid Commission
Chapter 1. California Student Aid Commission
Article 4.5. Cal Grant Program Appeal Process and Appeal Criteria
5 CCR Div. 4 Ch. 1 Art. 4.5 App. A
Appendix A CSAC APPEAL CERTIFICATION FORM
Currentness
Purpose: The purpose of this form is to certify institutions, who have lost eligibility during the certification process, and wish to appeal with the commission in accordance with California Education Code 69432.7. Use this form to determine if your institution is qualified to appeal based on your cohort default rate and/or graduation rate.
Instructions: Please make sure all fields are completed. If qualified, send this form with a formal letter of request to appeal along with supporting documents. If you select NO at any point, your institution is not qualified to appeal. If you determine your institution is not qualified based on this form, no further action is required.
Institution Name: ________________________________________
OPE ID: ______________________________
Contact: ____________________ Email: ______________________________
Phone: ____________________
Please certify and complete the following:
1. My institution remains eligible for Title IV programs: Empty Checkbox​ Yes / Empty Checkbox​ No
2. My institution's cohort in question is 20 students or less for academic year _____: Empty Checkbox​ Yes / Empty Checkbox​ No
3. My overall institution Grad Rate for academic year _____ is above 30% Empty Checkbox​ Yes / Empty Checkbox​ No/ Empty Checkbox​N/A
4. The number of students that are listed on your roster for the current academic year: __________
5. The number of students that have received payment on your roster for the current academic year: __________
6. Attach a formal letter of appeal on school letterhead and include supporting documentation that you will use for your appeal.
I understand the commission is bound by the California Education Code 69432.7 and related regulations and is not permitted to make any exceptions for any reason for institutions that do not meet the statutory criterial for granting an appeal. Empty Checkbox​ Yes / Empty Checkbox​ No
Print Name: ___________________________________
Date: ___________________________________
Signature: ___________________________________
(Should be signed by the official who signed the Institutional Participation Agreement)

Credits

History
1. New Appendix A filed 9-21-2021; operative 1-1-2022 (Register 2021, No. 39). Filing deadline specified in Government Code section 11349.3(a) extended 60 calendar days pursuant to Executive Order N-40-20 and an additional 60 calendar days pursuant to Executive Order N-71-20.
This database is current through 4/26/24 Register 2024, No. 17.
Cal. Admin. Code tit. 5, Div. 4 Ch. 1 Art. 4.5 App. A, 5 CA ADC Div. 4 Ch. 1 Art. 4.5 App. A
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