SUSPENSION APPEAL REQUEST
Name: ______________________________________ Student Number (A#):________________________
Major: ______________________________________ Advisor: ___________________________________
Phone: ______________________________________ Email: _____________________________________
Address: ___________________________________________________________________________________
Student Signature: ____________________________________________ Date: ____________________
Instructions:
Form must be fully completed for consideration. Attach any supporting documentation that validates
mitigating circumstances (medical documentation, obituary, etc.). You may email the completed form and
supporting documentation to
admissions@gadsdenstate.edu, mail to GSCC Admissions Office, P.O. Box 227,
Gadsden, AL 35902, or submit in person to the Admissions and Records Office (One Stop Center, Gadsden).
The appeal form must be received by the deadline date provided.
W
hat circumstances prohibited you from meeting Academic Standards?
P
lease explain what changes have occurred that will enable you to meet Academic Standards in the future:
(USE REVERSE SIDE IF NEEDED) Rev. 9/20
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