Reinstatement and Grade
Issuance Appeal
Student Name: Student ID #:
Phone #: Term of Request:
I am requesting to be reinstated into the following course(s) from which I was dropped due to
non-payment of fees and tuition. Reinstatement request will only be considered for up to 2
weeks from the date grades were due for the course(s).
Course: CRN #: Instructor:
Course: CRN #: Instructor:
Course: CRN #: Instructor:
Please attach the following:
Student: Instructor(s):
Letter of explanation from student Instructor Feedback form
Explaining circumstances for non-payment Final Grade Change Form submitted
I understand that:
I have been fully informed that upon reinstatement I will have 24 hours (or one business
day) to pay all tuition and fees due for these course(S), or that I will be automatically
purged from the course(s). Payment may be made by credit card on-line or by calling the
CFK BUSINESS OFFICE at 305-809-3186.
If reinstatement is approved, my instructor(s) will be notified so that my grade for this
course(s) may be released and posted.
Requests received without proper documentation will be returned and not reviewed until
proper documentation is provided to the Committee and this could jeopardize the
timeliness of the Committee’s decision.
It is my responsibility to monitor my CFK email account for any correspondence from
the Committee regarding this request.
The Committee has the right to seek relevant input regarding this request from other
college departments, including instructors, and use this information in their decision-
making.
If I am receiving financial aid, military assistance, veterans’ benefits, or am an
international student, it is my responsibility to check with the appropriate office to
determine if this request will affect my benefits or status.
I accept the decision of the Student Services Appeals Committee as final and not
subject to further appeal within the college.
75.89(G) Reinstatement and Grade Issuance Appeal Revised 9/20/2019
Student Name: Student ID #:
By signing below, I certify that I have read and understand all of the information on this
form. I further certify that all statements and documentation provided by me in support of
this exception are truthful and representative of the facts.
Students signature: Date:
Submit your request for consideration to:
CFK Student Services Appeals Committee
fkccstudentappeals@fkcc.edu
The College of the Florida Keys, 5901 College Road, Key West, FL 33040
Phone: (305) 809-3215 Fax: (305) 292-5163
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