Fillable Academic Appeals Petition Form (Montgomery College)

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Academic Appeals Petition Form (Montgomery College)

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An academic appeal involves requesting an exception to a specific academic regulation as outlined on
this form. All academic appeals must include a completed Academic Appeal Petition Form,
personal statement, applicable signatures, and any supporting documentation. Email responses
from faculty sent to your MC email address can be accepted in lieu of physical signatures on the form.
Complete packets should be submitted to the Office of Enrollment Services at the campus where
the course(s) was last attempted. Use the instructions below as your guidelines for completing the
academic appeals process.
1. Contact a counselor to discuss your appeal. Indicate the specific regulation to be appealed on
Page 2.
2. Fill out the form. Type a personal statement explaining your appeal. Be sure to provide complete
information, including specific dates. Attach supporting documentation as applicable. Provide your
signature as the student.
3. You may attend the academic appeals meeting to provide clarification or additional information.
Attendance is optional. Indicate your preference of attending on Page 2.
4. If you received Financial Aid, you must discuss this appeal with the Office of Financial Aid and obtain
their signature. If you are an F-1 or M-1 visa holder, you must discuss this appeal with your International
Student Coordinator and obtain their signature.
5. Take your appeal form to the appropriate faculty member for recommendation, comments, and
signature. If the faculty member is not available, contact the department chair.
6. If your appeal is for more than a third attempt of a class, the department chair's signature is
required. You must also provide a typed detailed action plan that identifies what you will do differently
in retaking the course. This could include time management, work schedule, resources you will utilize
such as the tutoring centers on campus, study schedule, and changes you will make to ensure
successful course completion.
7. Obtain a counselor's signature on this form.
8. Submit a complete packet to the Office of Enrollment Services on the campus where you last
attempted the course(s). All documentation must be submitted 48 hours prior to the next academic
appeals meeting. Check the Academic Appeals website for campus meeting dates. Incomplete
packets will not be accepted.
9. Students will be notified of the appeal committee's decision by MC email within one week of the
meeting.
Full text of the Academic Regulations is available at https://cms.montgomerycollege.edu/EDU/Verified_-
_Policies_and_Procedures/PDF_Versions/53001_Academic_Regulations_and_Standards/
1
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Academic Appeals Process
Student Academic Appeal Petition Form
Please indicate the following regulation(s) you are appealing:
4.7A
Extend the deadline to change from credit to audit after the 20% meeting date of the course. (Petition
Campus Registrar, in writing, to extend the deadline to change from audit to credit. Do not submit
this form for audit to credit changes.)
Attempt a course for more than three times. Department Chair approval required. (Auditing a class
does not count as an attempt).
Extend the deadline to withdraw for reasons excluding being called to active duty, illness of student
or immediate family member, death of immediate family member, or work related reasons.
4.10B
Date Received
Meeting Date
2
ES 12/22/17
Name Student ID M-
Address
Program of Study/Major Telephone
Course
MC Email
Student Signature Date
Semester Year
Course
CRN
Semester
Semester
Semester
Year
Year
Year
Course
Course
Course
CRN
CRN
CRN
I plan to attend the appeal meeting:
(See website for meeting schedule)
Yes No
Has this been approved before?
Yes No
Approved
Denied
Deferred
8.3D1
Program requirements for graduation (time limit only). This is for students who are unable to complete
their degree program requirements within 7 years of when they began the declared major. Department
Chair approval required.
4.9A
2.6B/2.6C
Course substitution(s): You must file an appeal for substitution of more than nine semester hours (2.6B)
or for substitution of non-similar courses (2.6C) (e.g. lower-level for higher-level or different subject
designators). This does not apply to General Education Requirements. Attach the Course Substitution
Request Form. Department Chair approval required.
Required Course
Substituted CourseRequired Course
Required Course Substituted Course
Substituted Course
OFFICE USE
ONLY
Faculty Recommendation for Appeals Involving 4.7A, 4.9A, and/or 4.10B:
The student is required to obtain a recommendation from the faculty member of record (or department chair, if faculty are
unavailable) for any appealed course. Please review the appeal statement and relevant documentation. Indicate your
recommendation with specific reasons (e.g. attendance, including last date of attendance, and quality of work) and
sign the appeal.
Department Chair Recommendation for Appeals Involving 2.6B or 2.6C, 4.9A, and/or 8.3D1:
The student is required to obtain a recommendation from the department chair if this is an appeal for substitution of more than
nine semester hours (2.6B) or for non-similar course substitutions (2.6C), repeated courses (4.9A), or program requirements
time limit (8.3D1).
3
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Signatures and Recommendations
Recommendation:
Did you apply for or receive Financial Aid (scholarships, loans, and/or grants)?
If Yes, obtain signature below or attach MC email from the Office of Financial Aid. Comments:
Faculty Name Discipline
Last Date of Attendance
Required Counselor Recommendation for All Appeals:
After the student has obtained all necessary recommendation(s), review the appeal and relevant documentation. Please
address any questions about the appeal process, make certain the appeal form is complete, and ensure that the detailed
action plan for successful course completion is attached (if appealing for more than three attempts).
Counselor Name
Recommendation:
Are you an F-1/M-1 visa holder?
If Yes, obtain signature below or attach MC email from your International Student Coordinator. Comments:
Yes No
Yes No
Semester Year
Course
CRN
Select
One:
Attended
regularly
Did not attend regularly Never attended
Department Chair Name
Recommendation:
Has the student submitted a
detailed action plan for success?
Yes No n/a
Staff Signatures:
Financial Aid Officer Signature Printed Name Date
International Student Coordinator Signature Printed Name Date
Faculty Signature Date
Department Chair Signature Date
Counselor Signature Date
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Academic Appeals Petition Form (Montgomery College)

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Completed 18 July 2020

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