Northland Community and Technical College is an affirmative action, equal opportunity employer and educator. This document is available in alternative formats to
individuals with disabilities, consumers with hearing or speech disabilities may contact us via their preferred Telecommunications Relay Service.
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
click to sign
signature
click to edit