Last Name First Name Middle Initial Student ID or Social Security Number
Street Address City State Zip Code
_______________________________ _________________________________________________________________________ _____________________________________________
Phone Number Email Address Term and Year Requesting Reinstatement
By signing below I certify that I completed this appeal and that the information contained in this appeal is true to the best of my knowledge.
REQUIRED Student Signature: _______________________________________________ Date: _________________
~~~~~~~~~~ Appeal Decision and Conditions Office Use Only ~~~~~~~~~~
First-Time Suspension Multiple Suspension GPA _____________ Completion Rate____________%
Appeal is approved for: Academic Suspension Financial Aid Suspension
Approval Conditions:
You may register for _______________ term for no more than _________________ credits.
You are required to earn at least a 2.5 term GPA and 100% term completion rate.
You are required to register for the following course(s):_______________________________
You must complete mid-term self-evaluation reports for each class with your instructors.
You must attend a mid-term advising appointment by________________________________
You must bring COMPLETED mid-term self-evaluations to your advising appointment.
You must attend/complete 2 campus/GPS Lifeplan workshops and / or projects.
You will be unable to take advantage of early registration next term if you do not complete your
workshops & mid-term advising appt. with completed self-evaluation reports by the above date.
You must meet with an advisor by ______to review the terms of this appeal.
Appeal is denied for: Academic Suspension Financial Aid Suspension
Denial Reason(s):
Situation does not meet the definition of extenuating circumstances. Financial hold or balance due.
Failure to follow conditions of previous appeal. Other/Notes:
Missed appeal deadline.
Lack of documentation that supports your appeal.
A decision cannot be made at this time due to:
Academic Improvement Plan incomplete/missing. Lack of documentation.
CACP Initials / Date: ___________ Financial Aid Initials / Date: _____________ Admissions Initials/Date:_______________
7411 85
Avenue North
Brooklyn Park, MN 55445-2299
Counseling and Advising / ES 69 / 763-424-0703
Financial Aid / ES 46 / 763-424-0728
~~~~~~~~~~ Complete steps 1 - 3 below ~~~~~~~~~~
1. Check type of appeal:
Academic Suspension Financial Aid Suspension Both Academic & Financial Aid
2. Attach required information:
Completed Academic Improvement Plan Supporting documentation of extenuating circumstances
3. Submit completed appeal and attachments to the Counseling/Advising Office as soon as possible.
Important - Appeals submitted after the deadline will be denied. For deadline information, see .
If your appeal is approved, you will be notified via email to schedule an appointment to review the conditions of your
appeal with a counselor or advisor. Important Make sure the email you provide is up to date and that you check
it regularly. You must attend your appointment prior to future registration/class attendance.
NOTE: Please allow 7-10 business days for your appeal to be processed. If your Academic Suspension Appeal is approved, and your Financial Aid Suspension
Appeal is denied, you are responsible for full payment of tuition and fees. If you choose not to attend NHCC, you are responsible for dropping/withdrawing from
your classes.
Transfer Student Admissions Appeal
Academic Improvement Plan
Last Name First Name Middle Initial Student ID or Social Security Number
1. What are your reasons (extenuating circumstances) for falling below the academic progress standards?
(Extenuating circumstances may include student injury or illness, family emergency, etc.
You are required to attach supporting documentation, such as medical or legal statement, etc.)
2. Please explain how you plan to address any of the above issues.
(Example: What changes have you made? What services do you plan to use? How have any issues been resolved?)
3. Briefly describe your academic and/or career goals:
4. What courses do you plan to take if your appeal is approved? 5. What are your weekly time commitments? (Cannot
exceed 58 hours total)
Number of Credits Class/Study Hours
x 3 =
Work hours (per week) =
Updated 6/21/11