NAME STUDENT ID#
ADDRESS (must be your correct mailing address) PHONE #
(all information on this form MUST
be typed)
Please check all that apply:
academic appeal financial aid appeal
balance appeal
other
both (all appeals must be explained below)
APPEAL EXPLANATION (must be typed, please be specific, give details and attach any supporting documents):
ACADEMIC APPEAL FORM
Signature:
Please print and mail this form with supporting documents to: Connors State College, 700 College Road, Warner, OK 74469
(REQUIRED)
(i.e. -Spring 2013-BE SPECIFIC):
SEMESTER(S) INCLUDED IN THIS APPEAL (REQUIRED)
Please write the following on the lower corner: Attention Appeals Committee, RM#201, M. Hicks
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