Student Information
Name: Phone: Student ID#:
Address: City/State/Zip:
The Satisfactory Academic Progress requirements policy is found online at All credits attempted, as well
as all transfer credits are counted towards this maximum timeframe. You may appeal this status using this form, but it must be
submitted and approved prior to the end of the term for which you are requesting aid, or you will not receive aid for the term.
This form completed and signed by you and your advisor.
A written statement on a separate sheet of paper clearly addressing each requirement below. If you need assistance writing
your statement, the Writing Center is available in Tioga Hall, 3
Floor. Your statement should be typed, well thought out and
Statement Requirements
Please explain the choices you’ve made which lead you to make this request. You may not complete another request
with the same circumstances for which you have petitioned and been approved or denied.
Please provide your plan(s) for success in the future. If transferring, please include information on your transfer school
and their course requirements.
Note your overall educational goal(s). State your declared degree and what you intend to do with that degree.
Complete an Educational Development Plan (EDP) with your advisor. You can find an EDP online at
If possible- attach any applicable documentation for your extenuating circumstances that prevented you from completing your
program within the maximum timeframe. Documentation such as medical reports, accident reports, copy of a death certificate
and/or funeral notice is acceptable. If illness was a factor, provide documentation from your doctor indicating the onset,
duration, severity of your illness and whether you are healthy enough to return to school.
Note: Incomplete requests will not be reviewed and will be returned to you.
Answer The Following Questions:
My assigned advisor is
How often do you visit the Tutoring Center? never rarely occasionally often regularly
Have you applied for graduation? (circle one) Yes
Have you read and understood the Satisfactory Academic Progress Policy for Financial Aid recipients?
(circle one) Yes No
Continue to Back Side >
Satisfactory Academic Progress
Request for Reinstatement
Office of Financial Aid
1988 Newmark Avenue
Coos Bay, Oregon 97420
Phone: 541.888.7352 fax 541.888.7247
Email: | website:
Faculty Advisor Section
Please note that financial aid funds will only pay for credits required to complete the student’s program of study at Southwestern. I
certify that I met with and advised this student on the following date:
Date: _ Program of Study: Estimated Graduation Date: _
Please place a check mark next to applicable box (es):
This is the first time I have met with this student. I am this student’s regular advisor.
We have discussed Southwestern’s academic resources.
We have created a plan for success (note plan in comments).
Advisor Name: Advisor Signature: Date: _
What You Do Next
Continue to attend classes pending a decision from the Financial Aid Committee.
You may charge your books; however, you are 100% liable for the charges if your request is denied.
Should your request be denied, you will need to meet with a financial aid representative to determine how many credits
you will need to complete on your own funds to bring you back to satisfactory status. If you submit this request by the end
of the first week of the term, and it is later denied, you will be allowed to withdraw from classes and receive a full refund of
tuition and fees.
If you are not planning on attending, you must withdraw by the Wednesday of the second week of the term or be
responsible for all charges on your account.
Student Certification
By signing this request, I agree that the information provided is true and correct to the best of my knowledge. I agree that I have
reviewed, understand, and agree to the conditions, responsibilities and obligations to receive financial aid as stated in the Award
Booklet on the Financial Aid website.
Student Name: Signature: Date: _
Southwestern Oregon Community College does not discriminate on the basis of race, color, gender, sexual orientation, marital status, religion,
national origin, age, disability status, or protected veterans in employment, education, or activities as set forth in compliance with federal and state
statutes and regulations.
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