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Chippewa Valley Technical College (Chippewa Valley Technical College)

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Chippewa Valley Technical College
Request for Academic or Financial Aid Appeal
All students dismissed from CVTC may appeal their Academic Dismissal to be reinstated to the College. All students may appeal their
Financial Aid suspension to have their Financial Aid reinstated. Please check one:
I am appealing my Academic dismissal (deadlines below)
I am appealing my Financial Aid suspension (appeal immediately)
I am appealing both Financial Aid & Academic (deadlines below)
If you wish to appeal your Academic Dismissal or your Financial Aid suspension, you must submit this form and the following
information/documentation within the timeline indicated:
1. An explanation of the specific circumstance that prevented you from meeting the academic or financial aid standards and how you
have addressed the problem to ensure future academic success.
2. The following third party verification/documentation of the circumstances is attached. Refer to the Academic and Financial Aid
Appeal website to access a training video for completing an academic or financial aid appeal.
You are required to check a box(es) below and attach documentation. If documentation is not submitted and does not
support your circumstance, your appeal for reinstatement will not be reviewed.
Death of an immediate family member (mother, father, sibling, child, spouse, or grandparent). A copy of the death certificate or
obituary is required.
Medical condition which resulted in the inability to attend class or make contact to drop/withdraw. Medical documentation
including the dates of illness, admission to the hospital, or a signed letter from the doctor is required.
Family, financial, or legal situation that impacted your ability to succeed. A statement from a third party (family member,
health care provider, friend, faculty, or other advocate) is required.
Other (career choice, degree focus, time management, etc.) Provide documentation of steps you have already taken to address
your circumstance(s). Refer to the College Planning & Preparation (resources.cvtc.edu) website for CVTC resources.
I have checked with the Cashier’s Office and cleared all account receiveable holds. (Please note an appeal cannot be submitted
until all financial holds are cleared.)
If you were dismissed more than one semester in the past, you may appeal immediately. Appeals will be reviewed and a re-entry
decision will be communicated within 30 days via mail. If you were dismissed the previous semester, please see dates below:
Dismissal Term
Students May Submit AFTER:
Fall
April 1
Spring
July 1
Summer
November 1
*Deadline for appeal submission is 3 business days prior to the desired term.
The Satisfactory Academic Progress/Academic Standards (SAP/AS) Appeals Committee, is comprised of representatives from College
administration. If your appeal is approved and reinstatement granted, you are obligated to meet the requirements of your success plan.
Your plan will be evaluated at the end of the next term of enrollment to ensure that you met all requirements. If your appeal is denied,
you will be informed of your re-entry options. All committee decisions are final.
Complete the student contact information in the space below, and address the questions/statements that follow.
Last Name
First & Middle Name
CVTC Student Identification Number
PO Box/Street Address
Home/Contact Telephone Number
Academic: Financial:
City State Zip
Month/Year of Dismissal from CVTC
Academic: Financial:
Program Enrolled in at Time of Dismissal
New Program of Interest if Reinstated
Preferred ReinstatementTerm
(Fall/Spring/Summer)
Yes No Academic: Financial:
Is This Your First Appeal? If No, Term of Previous Appeal
Email Address
1
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OBSTACLES
Self reflect on the following items that may have been a barrier to your success the past two semesters. Use the the information on pages
2-3, along with the College Planning & Preparation (resources.cvtc.edu) website, to assist you in answering the questions on page 4.
Learning Habits
Too much
TV/Internet/Games
Too much social life
Overextended in my
Use cell phone too
much
Inadequate computer
skills
Failure to listen to
staff/faculty
Other _____________
Social Support
Significant
other/Children
problems
Household obligations
Roommate problems
Socially
uncomfortable/shy
Parental pressure
Physical abuse
Divorce or Separation
New Marriage
New independent
status
Family health
problems
Loneliness
Being Single
Other _____________
Financial
Worried about money
Financial aid
requirements
Inadequate Financial
aid
Spouse not working
Too many debts
Time limit on school
funds
Other _____________
Work-Related
Must work to survive
Work too many hours
Problems with the
boss
May lose job
Conflicts with the job
No part-time work
available
Conflicts at work
Other _____________
Personal
Stressed all the time
Cultural pressures
Relationship
worries/problems
Loss of family
member or friend
Depression
Substance abuse
Rape or assault
Health/Medical
worries
Illness
Housing problems
Value conflicts
Transportation issues
Commitment
Commuting
Negative attitude
Emotional abuse
Pregnancy
Family
Issues/Concerns
Lack of
computer/internet
Lack of phone
Lack of transportation
Other _____________
Prior Experience/
Perceptions
Previous failure
Not being perfect
Accomplishments
Pressures
Success
Making decisions
Making mistakes
Task too difficult
Don’t know who to
contact with concerns
Unhappy with
instructor
Impersonal instructor
Impersonal staff
Other _____________
Degree Focus
Core requirements
Academic Policies
GPA requirements
Parental pressure
Other pressure
Classes unavailable
Classes at conflicting
times
Classes/schedule not
convenient
Poor class selection
Selecting a program
Program/Major not
offered
Unclear education
goals
Unhappy with
program
Other _____________
Academic/Study Skills
Learning disability
Poor study habits
Poor note-taking skills
Poor concentration
Poor time
management
Poor study
environment
Ineffective studying
time
High anxiety
Inadequate preparation
Poor academic
advising
Failure to ask
questions when
working with
staff/faculty
Other _____________
Reading Confidence
Inadequate reading
skills
Verbal Confidence
Inadequate writing
skills
Math Confidence
Inadequate math skills
2
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SOLUTIONS
Solutions that are followed by an asterisk (*) indicate resources available on campus. See next page for a list of
campus resources.
Learning Habits
Work Related Degree Focus
Set goals* Search for a new job* Consult with CVTC
Reward yourself Develop problem Academic Advisor*
Online Success solving skills Use College Planning
Seminars* Find a job* & Preparation
Use to-do list Spouse gets a job Resources*
Time management Change position Consult with
workshop* within job instructor*
Turn cell phone off Reduce hours working Change program*
Other _____________ Quit job Change schools
Career Services Career Planning
Social Support
seminar* Workshop*
Discuss goals* Other _____________ Develop an Academic
Attend to children Plan*
first, and then require
Personal
Other _____________
solitude Stress management
Develop a routine* workshop*
Academic/Study Skills
Delegate duties Attend assertiveness Use face-to-face or
Take family member training workshop online tutoring*
to get medical help Meet with CVTC Study skills seminar *
Seek help with Student Success Use study skill self-
communication * Specialist * help
Attend parenting Seek personal brochures/materials
classes counseling in Visit with Instructors*
Attend marriage or community Change study
family counseling Attend group environment
Obtain family counseling Study on campus
planning help Visit a medical doctor Form a study group
Other _____________ Join club or Change instructors
organization* Ask questions during
Financial
Read self-help book academic advising
See financial planner Listen to motivational Access Online Learner
See tax accountant for tapes Resources
deductions Develop problem (MYCVTC)*
Contact Student solving skills* Know drop deadlines
Financial Assistance Online Success & procedures*
about loans/grants* Seminars* Utilize Disability
Explore credit for Take semester off Services*
prior learning while working on Meet with Diversity
options* problems Services Specialist*
Consider part-time Say NO! Test Anxiety
schooling Car pool/ride bus Seminar*
Meet with CVTC Change housing Watch an online
Financial Coach* situation technology support
GradReady Other _____________ seminar*
(MYCVTC)*
Other _____________
3
SELF-EVALUATION
Please address the following questions/statements. Briefly describe your situation/circumstance in complete sentence format.
1. CIRCUMSTANCES:
Describe the circumstances (death of an immediate family member, medical condition, family, financial, legal
situation) that may have contributed to your academic difficulties. If your circumstances are categorized as
“OTHER” (career choice, degree focus, time management, etc.), describe WHY these circumstances contributed to
your academic difficulties. Attach documentation to support your circumstances and steps you have taken to
address the situation, and achieve your educational goals at CVTC.
Documentation may include, but is not limited to, a letter from your employer supporting changes in work schedule or
flexibility with your school schedule, a transcript from another college identifying successful completion of courses, or
an attendance verification of Student Services resources utilized. Examples include, College Success Seminars you
have attended or watched online, Career Assessment completed, time spent in Adult Education Services, appointment
with an academic advisor or Student Success Specialist, or communication with other CVTC staff or faculty.
Documentation could also include a letter from a case manager, agency counselor, or CVTC staff member verifying
actions taken to address your circumstance. Please feel free to add additional pages if more space is needed.
4
2. CHANGING YOUR HABITS:
Identify and list a minimum of three items in your self evaluation that you believe will help you manage life
circumstances and improve performance in your classes if reinstated to the College.
1.
2.
3.
3. CAMPUS RESOURCES:
Identify and list a minimum of three campus resources you will use to assist you in identifying solutions and
overcoming barriers if reinstated to the College. See College Planning & Preparation
(resources.cvtc.edu).
1.
2.
3.
4. FUTURE SUCCESS:
How will the changes described above increase the likelihood that you will succeed if given another opportunity?
Please be very specific and detailed in your response. Please feel free to add additional pages if more space is needed.
Please make a copy of the completed appeal and keep for your records before submitting this form and
information/documentation of circumstances to:
By Email: academic_standards@cvtc.edu
*To send electronically, please “save as” to your
computer and then attach to email.
5
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Completed 9 October 2020

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