Northland Community and Technical College is an affirmative action, equal opportunity employer and educator. This document is available in alternative formats to
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APP
EAL/PETITION FOR REINSTATEMENT OF FINANCIAL AID
Federal regulations state that a student who has experienced undue hardship due to (a) the death of a family member, (b) the personal injury or
serious illness of a student, or (c) special circumstances as determined by the institution; may be considered for a reinstatement of aid.
PART 1 – TO BE COMPLETED BY STUDENT
Name: Major:
Star ID/Student ID: Phone Number:
Current Mailing Address: City/State/Zip:
Email: ______________________________________________________________
I a
m appealing: _________ Financial Aid Reinstatement ________ 2
nd
Level Financial Aid _________ 150%
I request the reinstatement of financial aid beginning: Fall Spring Summer
Use reverse side or attach a separate sheet to explain your situation.
• WHAT CAUSED YOU TO BE UNSUCCESSFUL IN YOUR CLASSES? INDICATE UNUSUAL CIRCUMSTANCE/S;
MUST INCLUDE DOCUMENTATION (Example: obituary, doctor’s note, etc.)
• WHAT WILL YOU DO TO MAKE YOURSELF SUCCESSFUL? WHAT HAS CHANGED? YOU MAY NEED AN
ACADEMIC IMPROVEMENT PLAN SIGNED BY ADVISOR.
Th
e information provided herein is true and correct.
Student’s Signature Date
PART II – TO BE COMPLETED BY THE OFFICE OF FINANCIAL AID
[_____] Approved for trial period: Term__________________________________
Conditions of your trial period:
______You must successfully meet cumulative standards at the end of the term (67% cumulative completion and 2.0 cumulative GPA)
complete 67% of all credits attempted and meet the satisfactory academic progress GPA standard for financial aid upon completion of
the term.
______ You must pass of your attempted credits with a minimum GPA until the minimum requirements of the financial aid
satisfactory academic progress policy are reached.* See Academic Improvement Plan for details.
______Other conditions: ________________________________________________________________
[______] Disapproved:
______
Extenuating circumstance did not rise to the level needed to support an approval of your suspension appeal.
_____ Documentation of extenuating circumstance was not provided or was insufficient.
_____ Your past academic history and plan for success does not support an approval of your suspension appeal.
_____ Conditions of a previously approved appeal were not met.
______ Other: ________________________________________________________________________________________
FI
NANCIAL AID DIRECTOR SIGNATURE ________________________________________________________ DATE________
VIC
E PRESIDENT/DEAN OF STUDENT SERVICES SIGNATURE _____________________________________DATE ________
(2
nd
level appeals)
*NOTE: A “W” on your transcript is considered an attempted but not completed course. Therefore, you must not receive a “W” in a
term you are required to complete of attempted credits.
Financial Aid Office initials and date:
click to sign
signature
click to edit
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click to sign
signature
click to edit
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