Fillable form must be submitted by February 1, 2021 (Leeward Community College)

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form must be submitted by February 1, 2021 (Leeward Community College)

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1
Application to Appeal Academic Warning, Probation,
Suspension & Dismissal Statuses
Please complete this form if you want to appeal your Academic Warning, Probation, Suspension or Dismissal status. This
form must be submitted by February 1, 2021 to leeward@hawaii.edu via UH Filedrop for it to be considered.
Instructions for filedropping this document are on page 3. This is what you can expect to take place via this appeals
process:
1. Complete a
nd submit the online appeal application by the above deadline. Please use your UH email address
when submitting the form, and include any supporting documentation you may have.
2. Once rec
eived, your application will be forwarded to a counselor who will do an initial review and make
recommendations based on your responses.
3. Your app
lication will then be forwarded to the Dean of Student Services who will make the final decision to
approve or deny your application.
4. Should your application be approved you will be allowed to enroll in the upcoming semester. You will be
required to develop an academic success plan with a Counselor before you will be permitted to register for
classes.
5. Studen
ts must register themselves for classes in STAR-GPS.
Please no
te that until these steps have been taken, students who are placed on Academic Suspension or Dismissal will
be ineligible to enroll in any Leeward CC credit courses for the current term. Students who are already registered will be
administratively dis-enrolled from all of their Leeward CC courses and will receive a 100% refund for any tuition paid.
If you have any questions about your academic standing or the appeals process, please contact the Counseling Office
at (808) 455-0233 or at leeward@hawaii.edu
.
Please
tell us about yourself:
Last Name, First Name Student ID #
UH Email Address Other Email Address Phone Number
Your Major & Degree
Please tell us about your situation:
What Academic Sanction are you appealing?
Academic Warning
Academic Probation
Academic Suspension
Academic Dismissal
2
Please explain why you would like your academic status to change.
Please describe and explain in detail your reasons for being on Academic Warning, Probation,
Suspension or Dismissal. Please add additional pages as needed.
3
Ple
ase describe and explain in detail what changes you will be making to earn better grades at Leeward
Community College. Please add additional pages as needed.
If you have additional information to share, please let us know here. (Optional)
Student Certification:
I certify that I am the person listed on this form and that I am requesting this change to my
educational record.
Instructions for UH Filedrop:
1. From any web browser, go to https://www.hawaii.edu/filedrop
2. Click on the green box on the right side of the screen asking you to login.
3. Click the Login Here link, and login using your UH username and password.
After you've logged in, you will be redirected to a page that allows you to input a recipient.
4. In the recipient field, type: leeward@hawaii.edu.
5. You will need to retype this in the Confirm Recipient field.
6. Check the box for Require Authentication.
7. After you've filled out both Recipient fields, click Proceed.
8. Click the Choose File button to browse document files.
9. Click the Start Upload button.
10. You will be redirected to a confirmation page with the link to your uploaded file. You're finished!
4
A
DMINISTRATIVE SECTIONS
To be Completed by the Leeward Community College Employees
Counselor Review
Na
me of Reviewing Counselor
Bl
ake Hunrick
Stu Uesato
Jonathan Wong
Other _______________________
Co
unselor’s Recommendation
Approve
Deny
Explanation for the Recommendation (whether approved or denied) :
The
Student should be limited to taking the following number of Credits this Semester
3 o
r less
4-6
7-9
10-12
I do not recommend a credit limit
El
ements that should be included in the Student’s Success Plan
Counselor Certification:
I certify that I am the Counselor listed above and that I am making the above recommendations.
5
Dean
of Student Services Office
To be Completed by the Dean of Student Services
Appeal Dec
ision:
Appro
ve
Deny
Recomm
endations:
Date:
Signature
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Completed 3 February 2021

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