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Academic Standing Appeal
Student Information
Complete all questions below, and forward to your academic advisor no more than
5 business days
the date of the notification of withdrawal from the Registrar's office.
Student ID:
Student Name:
Academic Program:
Advisor Name:
See the notification letter you received from the Registrar’s Office to complete the following questions
if applicable:
Term completion ratio:
Cumulative completion ratio:
complete the following items:
Registered or anticipated courses and credits for upcoming term (list all courses and credits):
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What are the factors that have contributed to your current academic standing status? Be aware
that documentation may be required. Please be specific.
If allowed to continue for another term on probation, what will you need to do to achieve academic
success? Please be specific.
Do you have additional information to convey to your advisor? If so, please use the space below.
Student Signature*: __________________________________________ Date: ___________________
*Note: Your electronic signature is acceptable in lieu of a hard signature if provided via an antioch.edu email account.
Once complete, forward to your advisor. Your advisor may require a conversation with you before
they can make a recommendation. They may also request documentation of specific claims that you
Advisor Response
Your advisee has been recommended for withdrawal due to not meeting Antioch's Academic Standing
standards. They are appealing this recommendation and requesting an additional term on probation. You may
require a conversation with your advisee. You may also require documentation to support specific claims made
by your advisee if you feel it is appropriate. Please complete this form and forward to registrar@antioch.edu no
more than 5 business days after receipt from the student. Please note: AULA advisors must forward their
recommendations to the Academic Appeals Committee, Attn. Emee Dacanay
Do you approve of granting the student a probationary term?
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If no, please provide a brief explaination of your decision not to approve another probationary
term. This information will be shared with the student.
If yes, are there changes you request the student make to their academic schedule for the coming
If yes, are there resources you believe would improve the student's academic performance?
Some students may need to be placed on Academic Plan Probation rather than Probation.
An academic
plan is required when it is not possible for the student to return to good academic standing by the end
of the probationary term. The plan to return to good standing may not exceed 3 terms.
If a plan is required, it must be submitted to the
Registrar's Office prior to registering for the next
term. Please indicate academic plan will be required:
Advisor Sig
Note: Your electronic signature is acceptable in lieu of a hard signature if provided via an antioch.edu email account.
click to sign
click to edit