05/18/2020
FINANCIAL AID APPEAL REQUEST FORM
VICE PRESIDENT OF STUDENT SERVICES
170 North Street, Room 229
Dryden, NY 13053
Phone: 607.844.8222, Ext. 4316 Fax: 607.844.6544
Email: VPSS@tompkinscortland.edu
_________________________________________
(Semester/Year for which aid is being requested.)
Name: Student ID #: __ __ __ - __ __ - __ __ __ __
Street
Address: Cell phone #: ( _____ ) _______________________
City, State, Zip: Home/other #: ( _____ ) ________________________
E-mail: @mymail.tc3.edu Date: _______________________________________
(For your security, only your Tompkins Cortland email address will be used for communication regarding your appeal request.)
I believe that I experienced extenuating circumstances during the _______________________ semester
which resulted in my being placed on Financial Aid Suspension and/or the N.Y.S. TAP Hold List after
already being placed on probation in the previous semester.
I am submitting an appeal form and supporting documentation. I understand that an approved appeal is
required in order to continue to receive any grants or student loans.
I understand that I can only get one appeal approved while at Tompkins Cortland.
I am aware that:
1.
) Any outstanding Tompkins Cortland tuition bills must be paid in full (or payment arrangements have been
made) before I can register;
2.) I must be officially admitted by the College;
3.) My 2020-2021 FAFSA must be submitted and all financial aid doc
uments must be completed;
4.) PLEASE NOTE: If you are on both Academic Suspension AND Financial Aid Suspension, you must submit
BOTH of your appeals and supporting documentation no later than Sunday, June 14, 2020. Otherwise,
your appeal form and supporting documentation must be submitted to our office (Room 229) as soon as
possible, but no later than Thursday, August 20, 2020, for review by the Financial Aid Appeals Review
Committee.
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P
LEASE NOTE:
If you are on Academic Probation or returning from an Academic Suspension, contact the Student Success Office
regarding academic requirements for continuation at Success@tompkinscortland.edu
.
Students interested in on-campus housing must resolve this matter before their housing request will be
c
onsidered.
You will be notified to your Tompkins Cortland e-mail address of the appeal committee’s decision.
All appeal decisions are final. If you are not approved, you must pay out of your own pocket (with cash or credit
card) for all of your college expenses. You can only appeal one time no repeat appeals are allowed.
If your appeal is denied and you decide not to attend, you are still responsible for withdrawing from your courses
before the semester begins so that you do not incur any tuition liability.
**PLEASE COMPLETE ALL THREE QUESTIONS ON THE SECOND PAGE OF THIS APPEAL FORM.
SUBMIT THE FORM AND YOUR SUPPORTING DOCUMENTATION TO THE ADDRESS LISTED ABOVE.**
Financial Aid Appeal Request Form, Page #2
1. What were the specific extenuating circumstances that affected your academic performance at Tompkins Cortland?
Include the date(s) when the circumstances occurred. PLEASE NOTE: Extenuating circumstances DO NOT include
l
ack of funds, failure to understand or adhere to college policy, or dissatisfaction with an instructor or course.
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2.
How have the circumstances now been resolved so that they will no longer have an impact on your studies?
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3. Based on your answers to #1 and #2 above, what supporting documentation are you providing? Official
documentation must be attached to the appeal form. Your appeal request will only be considered by the Review
Committee if your circumstances fall within one of the categories below and documentation/verification is submitted.
Circumstances: Examples of documentation to be submitted.
Serious illness or injury to the student. Medical records, doctor’s statement (including effective
dates.)
Extenuating circumstances involving an immediate family
member (parent/legal guardian, sibling, child, spouse,
significant other).
Medical records, death certificate, legal documents
(including dates).
Other circumstances beyond your control (such as house fire,
flood, or other catastrophic event).
Official documentation verifying the event (including
dates).
Student ID# Student’s Signature
Phone Number(s)
05/18/2020
Date
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