Revised05/2015
Appeal for Reconsideration Form
OFFICE OF GRADUATE ADMISSIONS
4202 East Fowler Avenue, SVC 1036, Tampa, FL 33620
TEL: (813) 974-3350 FAX: (813) 974-9689
www.usf.edu/admissions
INSTRUCTIONS: This request must be submitted directly to the graduate program and must be processed within 12 months
of the original admission for which an appeal for reconsideration is being sought. For program locations, go online to:
http://www.grad.usf.edu/programs/search_all.php. Please fill out your Personal Information, Term of Re-Entry and Graduate
Program sections completely: failure to do so will delay the processing of your request.
ATTACH A COVER LETTER STATING THE REASONS FOR REQUESTING AN APPEAL FOR RECONSIDERATION.
University ID#:
Legal Name:
Last Name First Name Middle Name
Street Address
City / State / Zip Code
Telephone Number (please include area code) Fax Number (please include area code) E-mail Address
Signature of Student Requesting Reinstatement Date
TERM OF RE- ENTRY GRADUATE PROGRAM
Insert Term: Insert Major/Degree/Concentration:
(For Official Use Only)
DEPARTMENT RECOMMENDATION
____ Admit ____ Admit Conditionally ____ Admit 10% Exception ____ Deny
Justify
10% Exception or List Conditions:
Department Signature:
Date:
COLLEGE RECOMMENDATION
____ Admit ____ Admit Conditionally ____ Admit 10% Exception ____ Deny
Justify
10% Exception or List Conditions:
College Signature:
Date:
GRADUATE ADMISSIONS RECOMMENDATION
____ Admit ____ Admit Conditionally ____ Admit 10% Exception ____ Deny
Justify
10% Exception or List Conditions:
Admissions Signature:
Date:
