The University of Texas at Tyler
3900 University Boulevard, Tyler TX 75799
Phone: 903.566.7180 • Email:
Page 1 of 2 Revised: 02.2020
Student ID: ______________________________________ Date: ______________________________________
Printed Name: _____________________________________________________________________________________
Last First MI
Home Phone: ____________________ Cell Phone: ____________________ Work Phone: ____________________
Nature of Appeal
6-Drop Exception Review
Refunds / Past-due balances
Automatic excessive hours exemption for semester of graduation
Excessive hours exemption, other terms
Student Records / Enrollment (other than Medical Withdrawal; see reverse)
I. Carefully complete the student information section above.
II. Type and attach a letter stating:
A. The nature of your appeal, including a detailed summary and timelines of the extenuating / mitigating
circumstances and / or events that led to your need to file this appeal, and
B. The exact request being made and/or outcome desired as a result of your appeal, being as specific as
Note: This document is a required part of the appeal and is not considered to be supporting documentation.
III. Attach an up-to-date, advisor-signed degree plan including a timeline to graduation; your anticipated term of
graduation must be included. (See page 2 for exceptions)
Note: This document is a required part of the appeal and is not considered to be supporting documentation.
IV. Attach supporting documentation for the extenuating/mitigating circumstances and/or events identified in the
appeal. The submitted documentation should provide proof of extenuating circumstances, be current and/or
match the timeline presented in the appeal, and be relevant to the circumstances of the appeal. It is the
responsibility of the student alone to determine what supporting documentation is appropriate for their appeal,
and to obtain/attach those items.
V. Submit completed form with all required documentation to the One-Stop Service Center (STE 230).
VI. Await your official appeal outcome message, which will be sent to your Patriot email account.
By signing below I confirm that I have read and understand all instructions on page 1 and all
additional information on page 2 of this document.
Signature: _________________________________________________________________________________________
For use by university officials only.
Please verify all three required components of the application for appeal.
Letter concerning nature of appeal
Signed, up-to-date degree plan Checked By: __________
Supporting documentation
click to sign
click to edit
Page 2 of 2 Revised: 10.2016
Any appeal submitted for Student Records/Enrollment without proper supporting documentation, as outlined above,
will be automatically denied as incomplete/invalid and will not be reviewed by the Student Appeals Committee.
Certain items may not be appealed, and any such requests will be automatically denied as invalid. These include, but
are not limited to, the following:
o Academic Probation/Suspension status
o The Repeating Courses policy
o Complete removal from the transcript of grades or other data related to any course a student was enrolled as of
the relevant Census Date.
Financial Aid appeals are not handled via this form; please refer to the Financial Aid webpage for more information.
Grade appeals are not handled via this form; please consult with your instructor or Department Chair.
Medical Withdrawals are not handled via this form; please refer to the Office of the Registrar’s Withdrawals website for
more information on the medical withdrawal process, and complete the Application for Medical Withdrawal / Course
Load Reduction form to initiate a medical withdrawal.
All responses concerning appeal outcomes will be sent via Patriot email.
Waivers of non-resident tuition due to Excessive Hours granted via appeal are for a single semester only; students
requesting waivers in multiple semesters must re-appeal each semester.
The circumstances listed in this section are the only scenarios in which a student is excused from some portion of the normal
Students appealing for a waiver of non-resident tuition charges due to excessive hours during their semester of
graduation are eligible for a one-time-only automatic approval. Submission of the Application for Graduation and
Application for Appeal (with typed statement) forms fulfills the requirements for this special approval.
Students applying for a waiver of non-resident tuition charges due to excessive hours outside their semester of
graduation, or who have previously exhausted their one-time automatic approval, must supply full supporting
documentation per normal procedures, as well as written confirmation from their Academic Advisor that all
courses enrolled in for the semester the waiver is being requested for are required for their degree plan.
Transient and Non-Degree Seeking students are excused from the degree plan requirement.
Freshman-level students still required to enroll through Academic Success may submit a UT Tyler Core Curriculum
Check-Off Sheet in place of a degree plan, and do not have to include an anticipated term of graduation.
Undecided undergraduate students, who are not freshman required to enroll through Academic Success, must submit a
core curriculum review and general summary of minimum upper-division requirements to earn a degree. These may be
obtained from academic advisors in the College of Arts and Sciences Advising Center (FAC 2019- 2021).
Students appealing for a 6-Drop Exception Review must submit the typed letter listed as item II under Instructions on
the first page of this document. This letter must include a list of each “W” grade the student wishes to have reviewed
for an exception from the 6-Drop rule including the course prefix and number (EX. MATH 1314), the semester the
course was withdrawn from, what institution it was taken at in the case of transfer credits, and which exception each
course is to be reviewed under. Appropriate documentation must be supplied in support of the claimed exemption
reason for each course.
The 6-Drop policy, available exception reasons, and lists of appropriate/acceptable documentation for each reason can
be found online at the following website:
For further information, review the Academic Grievances policy under the Undergraduate Academic Policies section of the
Catalog, which you can reference online at