Office of Academic Affairs
Academic Disqualification Appeal Form
Undergraduate Students
Advisor Recommendation
Your departmental advisor’s recommendation is needed for your disqualification to be reconsidered. If possible,
send your appeal essay to your advisor before meeting with them.
If you are appealing to a different major from your current one fill in the proposed major here: _____________
< Departmental Advisor Section - Please Fill Out After Meeting with the Student >
Check one of the two choices below:
I DO I DO NOT recommend that this student’s academic disqualification be reconsidered.
Advisor Signature: _______________________ Department: __________________
Date: _____________
Reason: _________________________________________________________________________________
If the department recommends the appeal, fill out the courses the student would take if readmitted.
Term: Summer
Fall Spring 20____
Major: ___________________
Name:
NYU ID: ______________________
Semester of Disqualification: __________________
Semester of Proposed Return: ____________________
The Appeal Decision
This form, your appeal essay and academic record will be reviewed by the by the Disqualification Appeals
Committee for a final
decision regarding readmission.You will be notified by e-mail of the committee’s
decision within one week.
3.____________________
4.____________________
Term: Summer
1.____________________
2.____________________
1.____________________
2.____________________
Fall Spring 20 ____
3.____________________
4.____________________
The Appeal Essay
Write an appeal essay explaining what caused you to be academically disqualified.
Why do you think you would be more academically successful if you were readmitted?
NOTE: Be as specific as possible in your appeal plan. What you would do differently?
What support services would you use? What other actions you would take that would enable you to succeed?
Submitting Appeal Form
If your appeal is approved by the department you should submit (1) this completed form (2) and your
appeal essay, to the Director of Academic Affairs via e-mail <mc3378@nyu.edu> or in person to LC 218.
If you have any questions e-mail Michael Campbell, the Director of Academic Affairs <mc3378@nyu.edu>
_________________________________________________________________________________
<< Appeal Deadline: To be considered, all appeals must be submitted 3 weeks before the first day of the semester >>
________________________________________________________________________
International student:
Yes No
The Appeal Process Steps
1
2
3
4
Date: ___________________________
click to sign
signature
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