Request for Maintenance of Matriculation
(MAINT-UY 4747) Undergraduate Students
After reading the appeal essay and discussing the student’s situation with them, check the appropriate box:
I DO recommend that this student be able to enroll in MAINT-UY 4747.
I DO NOT recommend that this student be able to enroll in MAINT-UY 4747.
Adviser Signature: ___________________________ Department: Date: ___________
Explain in a letter why you were not able to complete your academic requirements in the time allotted.
Attach to this form.
Univ. ID: Major:
Semester Proposed MAINT-UY 4747 enrollment (semester/year):
Check if International Student:
Submit the fully completed form to the Office of Academic Affairs, LC230. If your request is approved, you
will be enrolled in MAINT-UY 4747 for one semester. If the request is denied, notification will be sent via
email. Note: You must pay the course fees for this enrollment.
For Records & Registration Office Use Only
Office of Academic Affairs LC230:
OGS (if International student):
Student registered by: Date:
Your adviser’s recommendation below is needed for your application to be considered.
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