Quincy College
Financial Aid Office
Phone: 617-984-1620
Email: financialaid@quincycollege.edu
ACADEMIC'APPEAL'FORM!
For!Title!IV!Financial!Aid!Recipients!
Our!Records!indicate!that!you!are!not!meeting!Satisfactory!Academic!Progress!as!required!by!the!Department!of!
Education .!Please!complete!this!form!and!return!it!with!your!supporting!doc um enta tion!for!review.!Supporting!
documentation!is!required!to!be!included!with!this!form.!Please!allow!two!weeks!for!review.!!
Please!check!the!ap plicable!reason!below!and!attach!a!detailed!explanation!with!supporting!documents.!
I!have!experienced!a!significant!medical!illness,!injury,!or!personal!tragedy!in!m
y!life!that!directly!affected!my!
ability!to!meet!academic!standards.!Attach!a!detailed!explanation!of!the!situation,!including!the!severity,!length!
of!time,!and!how!the!occurrence!specifically!affected!your!schoolwork.!Include!su pporting!documentation!(i.e.!
doctor's!statement,!hospital!bills,!letter!on!letterhead!from!a!counselor,!minister,!or!police!officer,!etc.!
There !was!a!death!of!a!close!relative!or!friend!and!this!directly!affected!my!ability!to!meet!ac
ademic!standards.!
Attach!a!detailed!explanation!noting!how!t he !death!specifically!affected!your!schoolwork.!Include!the!dece ased!
person's!name,!their!relationship!to!yo u,!and!the!time !frame!or!their!passing.!Include!supporting!documentation!
(i.e.!obituary,!funeral!notices,!etc.)!
A!significant! event!or !situation!occurred,!such!as!a!change!of!major,!change!in!work!sche dule,!etc.!Attach!a!
detailed!explanation!noting!the!circumstances!and!how!the!occurrence!affected!your!ab
ility!to!meet!academic!
standards.!
All!grades!that!affect!your!Grade!Point!Average!(GPA)!and!satisfactory!academic!progress!must!be!explained.!Please!be!
aware!that!completion!of!this!form!does!not!guarantee!approval!of!your!appeal!or!receipt!of!any!financial!aid!benefits.!
Name:! Student!ID!#!
Address:!!!
SSN!#! Cell!Phone!#!
Student’s!Signature:! Date: !
Please'Note:!If!your!appeal!is!based!on!a!medical!reason,!you!must!provide!current!documentation!from!your!physician!
that!indicates!you!are!able!to!return!to!your!studies.!Submit!this!completed!form!and!supporting!documentation!to:!
Financial'Aid'Office'
Quincy'College'Suite'203'
1250'Hancock'Street!
Quincy,'MA'02169''
Attn:'Associate'Director!
FOR'OFFICE'USE'ONLY' APPROVED! DENIED! PENDING!APPROVAL!
Signature!of!Associate!Director:! Date:!
click to sign
signature
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signature
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Please write an explanation of your appeal. Include any required
documentation. Be sure to explain how you plan to
improve your grades.
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