Admissions and Outreach Office
North Hennepin Community College
Brooklyn Park, MN 55445
Last Name First Name MI Social Security Number
Street Address City State Zip
____________________________ ______________________________________________ _________________________________
Phone Number Email Address Term and Year Requesting
~~~~~~ Complete steps 1-3 below~~~~~~
1. Check type of appeal:
Missed Deadline Academically Do Not Qualify Did Not Meet Required Reading Level
2. Attach required information:
Explanation for Appeal Request Supporting Documentation of Extenuating Circumstances
3. Submit completed appeal and attachments to the Admissions & Outreach Office within 7 business
days of the published application deadline.
* If your appeal is approved, you will be notified via email. Please make sure the email you
provide is up to date and that you check your email regularly.
NOTE: Please allow 7-10 business days for your appeal to be processed. Only 1 appeal can be submitted per
semester (for any reason). Appeals to test a 4th time will not be approved.
By signing below I certify that I completed this appeal and that the information contained in this appeal is true to
the best of my knowledge.
STUDENT SIGNATURE_______________________________________________________ Date______________
itials: __________ Date: __________
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