TELS Request for Reinstatement
Due to Grade Change
Name______________________________________________Date_________ Student ID_____________
Last First M.I.
Students who obtain a grade change shall notify the Financial Aid Office within 30 calendar days of the grade change and
request reinstatement of the TELS Award. Request shall be made by submitting this form and required documentation to
the Financial Aid Office.
If a grade change makes a student eligible for a TELS award, the student can be awarded retroactively in the current
award year. If the grade change affects the student’s eligibility from the previous award year, the TELS award may be
adjusted in the current award year. If the reinstatement of the award results in either an overaward situation, or exceeds
the institution’s cost of attendance for any semester, the institution shall make the necessary reductions in the student’s
financial aid package.
Denial of a request for reinstatement of TELS Award(s) can be appealed through the TELS appeal process.
I hereby request reinstatement of my TELS Award(s) for the ______________semester for the following reason:
semester/year
A grade has been assigned for a class in which I previously had an incomplete
Attach notification from the Office of Admissions and Records listing the course and term which had
been assigned the Incomplete, the date of change and letter grade assigned to the course, and the
new TELS Cumulative GPA.
A grade for a class taken at Dyersburg State Community College has been changed
Attach notification from the Office of Admissions and Records explaining the nature of the error,
which grade was corrected and when it was corrected, and the new TELS Cumulative GPA.
A grade has been changed for other reasons
Attach notification from the Office of Admissions and Records explaining which grade was changed,
when and why it was changed, and the new TELS Cumulative GPA.
I certify that the information and documentation submitted for appeal is true and accurate to the best of my knowledge.
____________________________________________ ____________________________________________
Student Signature Date Parent Signature (if student is dependent) Date
OFFICE USE ONLY
Receipt Date__________________
Approved_______ Denied_______
By_____________ Date________
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