Fillable TO: Academic Advisor FROM: Office of Student Financial (Governors State University)

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TO: Academic Advisor FROM: Office of Student Financial (Governors State University)

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TO: Academic Advisor
FROM: Office of Student Financial Aid
DATE: ____________________
RE: Request for Written Evaluation of Academic Performance
To comply with federal regulations, Governors State University is required to monitor whether a student
is maintaining satisfactory academic progress in his/her course of study. Students who have been denied
financial aid eligibility because they have not met the requirements of the Satisfactory Academic Progress
Policy are offered the opportunity to submit an appeal to regain their financial aid eligibility. As part of
the appeal, a student must document extenuating circumstances that prevented him/her from meeting
the requirements.
Before the Satisfactory Academic Progress Appeal Committee may consider a student’s appeal, the
student is required to obtain a written evaluation of his/her past and potential academic performance at
Governors State University. Your evaluation will be treated as confidential and will be reviewed only by
the Satisfactory Academic Progress Appeal Committee and financial aid staff as necessary.
The student presenting this document and Evaluation of Academic Performance Form to you will sign
below that he/she authorizes your release of information. Once completed, please return to the student
so that they may submit along with their appeal or email to faid@govst.edu. Thank you in advance for
your cooperation.
STUDENT NAME: ___________________________________________________GSU ID#: ____________________________
I hereby authorize the release of information regarding my academic performance at Governors State
University. I understand that this is a necessary component of my Satisfactory Academic Progress Policy
Appeal and that the information will be released only to the Office of Student Financial Aid.
SIGNATURE:______________________________________________________________DATE: __________________________
Enclosed: EVALUATION OF ACADEMIC PERFORMANCE FORM
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EVALUATION OF ACADEMIC PERFORMANCE
(To be completed by academic advisor)
Student Name: _________________________________________________________________________ GSU ID#: ____________________________
1. When did you begin advising this student? _______________________________________________________________
2. Are you aware of any extenuating circumstances that have hindered the student’s past academic
performance? If so, please comment:
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
3. Per the Satisfactory Academic Progress requirements, students must meet the following academic
requirements: 1) Must have a cumulative grade point average consistent with the academic
standards for graduation and 2) Complete with a passing grade 67% of the courses attempted.
Based upon the student’s current academic record, what is your assessment of the student’s
potential to meet these requirements within the next few semesters?
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
____________________________________________________________________________________
4. DEGREE PLAN:
# Semester hours required to complete degree requirements __________________________________________
# Semesters the student will be enrolled to complete the requirements _______________________________
Evaluation completed by __________________________________________________________
College: _________________________________________________________________________ Phone: ____________________________
Academic Advisor Signature: ______________________________________________ Date: _________________________________
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TO: Academic Advisor FROM: Office of Student Financial (Governors State University)

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Completed 27 June 2021

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