STUDENT CERTIFICATION AND SIGNATURE
Attach supporting documentation of your unusual or extenuating circumstances. Documentation should be from someone who has
direct awareness of your situation. All extenuating circumstances and documentation must be dated to reflect the time periods for which
you were not meeting SAP standards. Documentation may be very personal, but the Committee must have some official record
reflecting supporting dates and facts beyond the student’s personal statement in order to make an informed decision on the merits of the
appeal. Your appeal and documentation will remain confidential.
The following types of documentation can be helpful if applicable:
• Illness: Detailed letter on letterhead from physician explaining dates and type of illness, recommended treatment, dates
of non-attendance, etc; admit papers confirming dates of absence;
• Death of family member: Death certificate, obituary notice, funeral program;
• Legal difficulty: Divorce decree, separation agreement, dated police reports detailing incident;
• Job conflict: Letter from supervisor on letterhead stating scheduling or other problems;
• Disability: Letter from counselor addressing problems during term(s) in question and resolution for future terms;
• Academic concerns: Statement below from academic advisor, counselor or instructor.
The student must meet with an academic advisor to complete the Advisor Section of the appeal and to go over a program
evaluation to ensure the student is on track for graduating in a timely manner and that only credits needed for degree completion are
taken. Complete the Student Section of the appeal BEFORE making an appointment with an advisor. Program evaluations may be
obtained from the Records Office or via your LancerNet Academic Profile. Student and academic advisor must sign the appeal form.
*Advisor: Please provide any additional information you may have for why this student’s appeal should or should not be approved.
Can the student successfully achieve his/her educational goals? Has the student overcome any obstacles he/she may have previously
faced? Is the student taking the appropriate type/number of classes for his/her ability and taking advantage of tutoring and other
resources available? Please indicate if you do
not feel you can support this student’s appeal for any reason (and provide an
explanation). The Appeal Committee needs an honest evaluation of this student’s capabilities and needs to know what advising
resources have been discussed (tutoring, career counseling, online advising, etc.) to help him/her be successful in the future. If you are
not comfortable giving the student back this form with your evaluation, you may submit it directly to the Financial Aid Office or e-mail
your statement directly to the Financial Aid Director.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Advisor’s signature: ________________________________________________ Date: ___________________________
Printed name: _______________________________________________________________________________________
Advisor: Signature of appeal indicates that the advisor has discussed resources available for the student’s success,
has reviewed the program evaluation with the student, and has approved classes listed as required for graduation.
By signing this worksheet, I certify that all of the information reported is complete and correct. I understand that I must complete all
classes with a grade of “C” or higher and not withdraw from any classes past the free drop/add period in order to regain SAP. I also
understand that if my appeal is denied, I am responsible for any outstanding charges and will have to continue my education at my own
expense until I regain Satisfactory Academic Progress standards.
Student signature: __________________________________________________ Date: ___________________________
ADVISOR SECTION • SAP APPEAL