Fillable Queensborough Community College - Appeal to the Committee on Course and Standing

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Queensborough Community College - Appeal to the Committee on Course and Standing

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Name _______________________________________________________________________________
Last First
Office of the Registrar
APPEAL TO THE COMMITTEE ON COURSE AND STANDING
For Office Use Only.
CCS Approved CCS Denied Initials _____________ Date ___________________________________
COMMENTS/REFERRED TO: __________________________________________________________________________
_________________________________________________________________________________________________________
Last Name ____________________________________________ First Name ______________________________________
CUNY FIRST ID #
On Your ID Card
Email _________________________________ Phone # _______________________
I WISH TO APPEAL FOR (CHECK BOX OR BOXES): Please ask the Registrar‘s staff or your adviser
for assistance if you are not sure which Withdrawals you may appeal.
Retroactive Withdrawal – Prior Semester(s) Late Withdrawal – CURRENT SEMESTER
WU GRADES ONLY – THE COMMITTEE CAN NOT CHANGE EARNED GRADES OF FIN, D, etc.
INC Extension DISMISSAL – Continuing Students Only
IF YOU WERE DISMISSED AND DID NOT ATTEND FOR AT LEAST ONE SEMESTER
SEE THE ADMISSIONS OFFICE (A-210).
Please list all courses you wish to change:
Course Semester/Year
Course Semester/Year
Course Semester/Year
Please answer the following questions carefully. Your answers are important to the success of
your appeal. If you need additional space, you may attach another sheet of paper.
1. Please explain the reason for your being on academic dismissal and/or your inability to withdraw by the deadline.
page 1 of 2 4/2017 218-17W
Name _______________________________________________________________________________
Last First
OFFICE OF THE REGISTRAR
APPEAL TO THE COMMITTEE ON COURSE AND STANDING
2. Do you have proof to strengthen your explanation above? (e.g. a letter from a health care professional,
record of hospitalization, birth/divorce/death certificate)
YES, I have proof to support my statement and will supply copies of my proof with this appeal.
List what credible/authentic documents you have attached:
NO, I do not have proof to support my statement (not having proof will weaken your appeal).
3. Moving forward, please explain how you plan on being more committed and what changes you are making to
insure success.
I hereby certify that all the information I have indicated on this form and any attachments are to the best of
my knowledge accurate and I realize that any misinformation may adversely affect this appeal, and/or would
subject me to possible Queensborough disciplinary actions
Signature _________________________________________________________ Date ____________________________
page 2 of 2 4/2017 218-17W
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Queensborough Community College - Appeal to the Committee on Course and Standing

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Completed 29 April 2020

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