2017-2018 Satisfactory Academic Progress Appeal Form-Form must be Typed and Printed
Last Name:
Name: First
ID: F00
UCA: @students.fairmontstate.edu
Phone: ________________________________________
Program of Study: Advisor (see note): GPA:
NOTE: Found on Felix by clicking on ‘Student & Financial Aid’, ‘Student Records’, ‘View Student Information’
Program Type: Associate’s (2 Year) Bachelor’s (4 Year) Master’s
# Hours Attempted: _ # Hours Completed: Completion %:
NOTE: Found on Felix by clicking onStudent & Financial Aid’, ‘Financial Aid’, ’Eligibility’, ’Select Aid Year’, ‘Academic Progress’
Do you have a previous degree? YES NO
If yes, when did you earn that degree and from where? ______________________________________________________________
1.
Indicate the semester you are requesting an appeal, submission deadline shown:
Fall 2017: August 4
th
Spring 2018: January 5
th
Summer 2018: May 16th
2.
Reason for federal financial aid suspension check appropriate statement (s)
I have not completed 67% of attempted hours.
I have not obtained my degree within 150% of the maximum time frame (See chart below).
I have not maintained the minimum overall grade point average required for the number of
credits I have attempted (See chart below).
Tot
al Hours Attempted
Minimum Allowable
GPA
Minimum Program
Hours
150% Completion
Less than 29
1.5
Associates: 60 Hours
90 Attempted Hours
30-59
1.8
Bachelors: 120 Hours
180 Attempted Hours
60 or more
2.0
Graduate
3.0
3.
Certification (Check each box as confirmation that you agree with the statement):
I unders
tand that the Financial Aid Office will not accept or process my appeal if it is incomplete or lacks documentation.
I understand that I may appeal to each level one time and I may only appeal to one level per semester.
I understand that there is no guarantee that the appeal will be approved.
I understand that I am responsible for making payment when the bill is due regardless of the status of the appeal.
I certify that all information submitted on this form and all supporting documentation is accurate, true and complete to
the best of my knowledge. I understand that any false information may be cause for the denial, reduction, and/or
repayment of student financial assistance and may subject me to a fine, imprisonment, or both under provisions of the
U.S. Criminal Code. I also understand that the Academic Plan that I am submitting may need to be modified after review
by Financial Aid.
Student Signature
Date
Date Received
Date Scanned
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signature
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Required Documentation
Complete the Personal Statement. MUST BE TYPED
Detail what has changed that will allow you to make Satisfactory Progress at the end of next semester.
Documents that support your request (i.e., statements from physicians, counselors, clergy,
medical records, court documents, birth/death certificates, obituaries, etc.)
Academic Plan developed with the assistance of your Academic Advisor or a member of the
Advising
Center staff if you have not yet declared a major.
Personal Statement
Describe the reasons and circumstances surrounding your insufficient academic progress. You must address HOW YOUR
CIRCUMSTANCES HAVE NOW CHANGED to allow you to be academically successful. Statements of “good intentions” are
not sufficient. Attach additional pages if necessary and attach all documentation. You must sign this form and all
supplemental pages.
4.
You may submit a Satisfactory Academic Progress Appeal for extenuating circumstances: (Check one)
Serious illness or injury that required extended recovery time
Death or serious illness of an immediate family member
Significant trauma that impaired your emotional and/or physical health
Other documented circumstances
ACADEMIC ADVISOR FORM
This part of the Satisfactory Academic Appeal Form is to be completed by the academic advisor or other
academic official to provide
information relevant to the request to continue eligibility for financial aid. The
information will be used in review of the student’s
appeal and is required for the appeal to be complete.
Submission of an appeal does not guarantee approval.
Student must complete:
Last Name: ___________________ First Name: __________________ ID: F00 __________________
Advisor must complete:
NOTE: Students area(s) of concern as detailed on FELiX under Financial Aid Academic Progress
Section 1: Complete this section only if the student has exceeded the 150% Maximum Time Frame
Degree Program and Major
Total
number of credit hours required for degree program
Current
number of earned credit hours (including transfer work)
Projected
number of additional attempted credit hours to achieve graduation
Academic Plan (Required)
Complete an academic projection for this student’s next three terms.
o (Can be fewer than three terms only if the student will graduate in fewer terms)
View SAP Guide for Advisors at:
o https://www.fairmontstate.edu/finaid/resources/satisfactory-academic-progress-policy
Complete SAP Worksheet for Advisors at:
o https://www.fairmontstate.edu/finaid/resources/satisfactory-academic-progress-policy
-Over-
Additional Comments:
By signing this document I am certifying that I have discussed the academic requirements/academic plan
contained in this
recommendation with the student.
Academic Advisor/ Academic Official Printed Name Title
Phone Email
Department/College
Advisor Signature
Date
I understand the academic requirements and/or academic plan recommended by the Academic Official. If I
intend to alter my
schedule or deviate from the academic plan, I will contact the academic official and the
Financial Aid Office. I understand that if I do
not, further eligibility for financial aid may be denied.
Student Signature
Date
For Office Use Only
Personal Statement
Academic Plan
Third Party Documentation
Previous Appeal: YES NO
Committee Decision:
Approval Denial Date: __________________
Member 1:
Member 2:
Member 3:
Director Decision: Approval Denial Date: ____________________
Terms of Approval/Contract:
GPA requirement: _____________________________________________________________________
Minimum Hours requirement: ___________________________________________________________
Semester requirement: ________________________________________________________________
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signature
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signature
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