REQUEST FOR
ACADEMIC BANKRUPTCY
OFFICE OF ADMISSIONS AND RECORDS • P.O. Box 2216 • Decatur, AL 35609 • 256.306.2500
Student must present a photo ID to process this request.
Name: _________________________________________________
_____________Student ID#:______________________________
Last First Middle
Address: _______________________________________________________________________________________________________
______________________________________________________________Email:___________________________________
City State ZIP
FOR OFFICE USE ONLY:
Approved:______ Disapproved:______ Transcript Notation: ___________________________________________________________
Registrar:___________________________________________ Date: ______________________________________________________
(REV 11/19)
Basic Guidelines:
The student must have completed 12 semester credit hours of coursework at the college since the most recent
semester for which the academic bankruptcy is requested. A grade of “C” or higher is required in each course in the
12 semester credit hours in the post-bankruptcy period.
Terms required for bankruptcy:
Term: Year:
1.______________________________ ____________
2.______________________________ ____________
3.______________________________ ____________
Important notes:
• Academic bankruptcy may be implemented only once;
• Academic bankruptcy may be applied to no more than 3 semesters
• The student may be liable for the repayment of any federal financial aid, veterans benefits, or other forms of
financial assistance;
• If transferring, the receiving institution may not accept the bankruptcy;
• All policies stated above are listed in the current college catalog.
Student Signature: ________________________________________________Date:_______________________
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