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 


 
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Request for Review of Academic Record for
Financial Aid Eligibility beyond the 150% Point
Students are expected to complete an associate degree by attempting no more than 150% of the credits required for the
degree. For an example, a program requiring 60 credits for graduation must be completed in 90 hours attempted. When
a student exceeds the maximum number of credits, the file will be reviewed for continued federal financial aid eligibility.
Name: ______________________________________ Campus ID: J____________
Address: _________________________________________________________________________
Phone Number: __________________ Expected Graduation Date (month/year): ________________
Degree Program: _____________________ Concentration (if applicable):_________________________
The following is my plan for graduation. I expect to take the following courses in the indicated semesters in order to
graduate by the date listed above (list ALL courses required for graduation). I understand that I may modify this
plan to take different courses as long as the new course selections fulfill a degree requirement. I will notify the financial
aid office if my plan changes or I change majors.
Course Semester Course Semester____________
I understand that if I withdraw or fail any of the courses, I may lose my financial aid eligibility
permanently at Jefferson Community College.
Student Signature: ___________________________________ Date: ______________________
Advisors: please sign below indicating that you have worked with this student to create a plan for
graduation as outlined above.
Advisor signature: ___________________________________ Date: ____________________
TKLs Iorm wLll not bH rHvLHwHG wLtKout an aGvLsor’s sLJnaturH
FOR FINANCIAL SERVICES OFFICE USE ONLY:
Total Number of Attempted Hours: _________ Total Number of Transfer Hours: _________
Total Number of Earned Hours: _________ Cumulative Grade Point Average: _________
Notes: ________________________________________________________________________________
Change of Major: _________________________________ Sap Code: ______ Completion Rate: _______
Transfer credits: _________________________________________________________
Previous Degrees: ________________________________________________________
Financial Aid Action: Approved Denied Signature: ___________________________
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