Revised 10/2014 Little Priest Tribal College Registrar P.O. Box 270 Winnebago, Nebraska 68071 (402) 878 3331
Academic Suspension Appeal Form
Name: __________________________________________________ Student ID: ___________
Phone: ____________________________ Email: _____________________________________
Mailing Address: ________________________________________________________________
Last term attended: Fall Spring Summer Year: ____________
Semester you wish
to return: Fall Spring Summer Year: ____________
Please answer the following questions and attach your answers to the appeal form along with all
supporting documentation (i.e. medical documentation) and return to the Registrar.
1. Provide a clear and concise explanation of the events/circumstances that were detrimental to
your academic performance during the last term enrolled and previous terms in which the term
GPA was less than 2.00.
2. Explain how your academic performance was affected by these events/circumstances.
3. Clarify how the events/circumstances have been resolved.
4. Describe your plans for ensuring satisfactory academic performance in the coming academic
term, should your appeal be approved. Additionally, what on and off campus resources will you
utilize to be academically successful?
Are you submitting documentation with the appeal? Yes No
All submitted documentation must specifically address the issues described in your letter of
explanation. When appealing based upon medical or psychological issues, please provide
statements from your health care provider that explain how your circumstances had an impact on
your academic performance.
Please list the documentation that will be provided.
_____________________________________ _______________________________________
_____________________________________ _______________________________________
_____________________________________ _______________________________________
_____________________________________ _______________________________________
____________________________________ ____________________________
Student’s Signature Date
Students who are academically suspended and whose appeals are not approved are required to sit out for one
full academic semester (not included summer sessions) before returning from suspension.