STUDENT APPEAL FORM
Procedures: Students wishing to appeal an exception to a Northland Community and Technical College policy should
complete this form and submit it to the registrar’s office for processing. Please see the other side of this form for detailed
instructions.
Name:
Star ID/Student ID:
Street Address:
Phone:
City/State/Zip:
Program:
Email Address:
Appeal for: Suspension/Academic Progress-You must schedule an appointment with a campus counselor or advisor
to complete an Academic Improvement Plan. If your extenuating circumstances are of personal nature, please
schedule an appointment with a campus counselor. This plan must be completed before your appeal will
be reviewed by the appropriate committee.
Grade Appeal - This form must be submitted within 30 days of the term posting date. The student is
responsible to discuss disagreements over a grade received with the instructor who assigned the grade.
*Tuition and Fee Refund for credits from the semester and year . Appeals concerning
tuition, fees, and late withdrawals must be submitted by the end of the following term (fall, spring, summer).
Some fees are nonrefundable. *If you received financial aid, please check with the financial aid office
before turning in your appeal. An approved tuition refund request may create a required repayment of
financial aid.
Other: ________________________________________________________________
Please attach a statement of your request to this appeal form
On a separate piece of paper clearly state your request. Be specific about the reason for your request and your
desired outcome. It is strongly recommended that appropriate supportive documentation, such as a doctor’s statement,
obituary, course syllabi, etc. be attached. See reverse side for additional information that must be included with this appeal.
_____________________________________________________ _______________________
Student Signature Date
____
_________________________________________________ _______________________
Campus Registrar Signature Date Received
***THIS SECTION MUST BE COMPLETED BY THE FINANCIAL AID OFFICE FOR TUITION REFUND REQUESTS***
Approving this tuition refund will result in the student repaying $_____________________________in financial aid funds.
____
______________________________________________FAO Signature _____________________________Date
FO
R OFFICE USE ONLY: Comments: _____________________________________________________________________
Recommendation: Approve Deny Table Decision: Approve Deny
_______
_______________________________________ _________________________________________________
Committee Chair Signature Date President/VP/Dean Signature Date
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Steps for Filing Student Appeal
Fo
rms
Complete the Appeal form accurately. Seek assistance from a campus counselor, advisor, or registrar if you
have any questions.
Financial aid reinstatement is a separate process. If you wish to request that your financial aid be reinstated you must
complete the Appeal/Petition for Reinstatement of Financial Aid form.
Wr
itten Information and Documentation
Clearly state your request, the reason for your request, and your desired outcome.
Briefly state what has impacted your situation. For example, if you are appealing a suspension or requesting a tuition
and fee refund, include information regarding any extenuating circumstances such as hospitalizations, illness, injury, or
death of a relative that affected your situation.
If you are appealing a suspension, it is very important to explain what has changed and what actions you have taken
so that you will be more successful if your appeal is approved.
It is strongly recommended that you attach documentation supporting your request. For example, if you are
appealing a suspension because you were hospitalized or a family member died, attach copies of medical forms or
obituary.
If you are appealing for suspension/academic program reasons you must schedule an appointment with a campus
counselor or advisor to complete an Academic Improvement Plan. If your extenuating circumstances are of a personal
nature, please schedule an appointment with a campus counselor. This plan must be completed before your
appeal will be reviewed by the appropriate committee.
In some cases, extenuating or unusual circumstance documentation is required in order to review your appeal.
Pr
ocess
Return the completed Student Appeal form and supporting documentation to the campus registrar. Appeal/Petition for
Reinstatement of Financial Aid forms also should be submitted to the campus registrar.
The campus registrar will assign the appeal to the appropriate appeal committee or administrator.
Students have the right to present their case in person to the committee at the committee meeting. Students must
notify the campus registrar of their decision to present their case in person at the time they submit their appeal.
Students intending to bring another person who can provide information regarding the appeal to the meeting must
notify the campus registrar at the time they submit their appeal.
The assigned committee or administrator will gather information, review the appeal and make a determination based
on the merits of the information provided.
Approval for readmission does not mean that financial aid is reinstated. Appeals for reinstatement of financial aid will
be reviewed by the financial aid director.
Students will be informed of the outcome of their appeal in writing.
Due Process Right
If your appeal is denied, you have the right to appeal the original decision to the next level if you have pertinent
information that was not considered previously or you feel the committee’s decision was unfair.
To appeal to the next level, you must complete the following steps within ten business days of the original decision:
o Submit a new appeal including information that was not previously considered and supporting documentation
along with a copy of the denied appeal to the campus registrar
o Notify the campus registrar at the time you submit the new appeal if you would like to present your case in
person
The registrar will submit the new appeal to the next level.
Students will be informed of the outcome of their appeal in writing.
Additional information regarding appeal processes may be found in the following policies at
www.northlandcollege.edu
by selecting About, scroll down, and click on Policies and Procedures:
3240
Student Complaints and Grievances
3070 Academic Progress
3430 Grade Appeal Policy
3120 Transfer of Credit Policy
1/14/2020 bgh
Northland Community and Technical College is an affirmative action, equal opportunity employer and educator.
This document is available in alternative formats to individuals with disabilities, consumers with hearing or speech disabilities may contact us via their preferred Telecommunications Relay
Service by dialing 711 (toll-free nationwide).
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