A. Student Information
B. Explanation and Documentation of Circumstances
YOU MUST ATTACH A COPY OF YOUR UNOFFICIAL TRANSCRIPT AND DEGREE WORKS. Check and complete the section
which best applies. Explanation and documentation should address all semesters in which you failed to successfully
complete class. Missing documentation and incomplete appeal forms will be denied – all documentation must be
included at the time you submit your appeal. No hand written statements; you must attach a typed statement.
Medical Condition: Explain the circumstances and attach a health care provider’s written statement(s)
confirming your medical condition(s) and supporting your decision to continue your enrollment.
Birth of Your Child/Adoption: Explain the circumstances and attach a copy of your child’s birth certificate or
documents regarding the adoption.
Death of Family Member: Explain the circumstances and your relationship to the deceased, and attach one of
the following: death certificate, obituary, or a written statement from a pastor or funeral director.
Divorce/Seperation: Explain the circumstances and attach supporting court documents.
Military Service: Explain the circumstances and attach a copy of official military orders.
Personal Issues: Explain the circumstances and attach a written statement from a professional third-party
resource such as a counselor, pastor, employer, professor, attorney, etc. confirming your situation and supporting your
decision to continue your enrollment.
Max Hours: Explain the circumstances that have prevented you from completing your degree and caused you to
acquire more attempted hours than are allotted per the SAP Policy. Attach a signed statement from your advisor or a
copy of your Degree Works stating how many hours you have left to complete.
C. Plan for Academic Success
Describe how your situation noted in Section B has changed to allow you to achieve academic success in the future.
Include any campus-based or external resources you have utilized. No hand written statements; you must attach a typed
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