Fillable form must be submitted by July 17, 2020 (Leeward Community College)

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form must be submitted by July 17, 2020 (Leeward Community College)

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1
Application to Appeal Academic Warning, Probation,
Suspension & Dismissal Statuses, Spring 2020
Please complete this form if you want to appeal your Academic Warning, Probation, Suspension or Dismissal status. This
form must be submitted by July 17, 2020 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. Co
mplete and 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. On
ce received, your application will be forwarded to a counselor who will do an initial review and make
recommendations based on your responses.
3. Yo
ur application 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. St
udents must register themselves for classes in STAR-GPS.
Pl
ease note 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
.
Pl
ease tell us about yourself:
Last Name, First Name
Student ID #
UH Email Address
Other Email Address
Phone Number
Your Major & Degree
Pl
ease tell us about your situation:
What Academic Sanction are you appealing?
Academic Warning
Academic Probation
Academic Suspension
Academic Dismissal
2
Do you wis
h to have the grading option changed to COVID-19 “No Credit (NC)” for all Spring 2020 classes where you
earned a D or an F? A “NC” grade indicates not passing, but the grade does not get calculated into your GPA; so, your
academic standing will automatically be revised. Please click here
for more information on the Spring 2020 CR/NC
opportunity. If you are receiving Veterans Benefits and do not want to have to repay the VA, please select “no.”
• Yes
• No
If you answered “yes,” please stop here and submit the form. If you answered “no” above, please continue.
Please ex
plain why you would like your academic status to change.
Please de
scribe and explain in detail your reasons for being on Academic Warning, Probation, Suspension or Dismissal.
Please add additional pages as needed.
Please de
scribe and explain in detail what changes you will be making to earn better grades at Leeward Community
College. Please add additional pages as needed.
3
If you have additional information to share, please let us know here. (Optional)
S
tudent 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. Save your document on your computer.
2. From any web browser, go to https://www.hawaii.edu/filedrop
3. Click on the green box on the right side of the screen asking you to login.
4. 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.
5. In the recipient field, type: leeward@hawaii.edu.
6. You will need to retype this in the "Confirm Recipient" field.
7. Check the box for "Require Authentication."
8. After you've filled out both Recipient fields, click "Proceed."
9. Click the "Choose File" button to browse document files. Find and select your saved document.
10. Click the "Start Upload" button.
11. You will be redirected to a confirmation page with the link to your uploaded file. You're finished!
4
ADMINISTRATIVE SECTIONS
To be Completed by the Leeward Community College Employees
Counselor Review
Name of Reviewing Counselor
Blake Hunrick
Stu Uesato
Jonathan Wong
Other _______________________
Counselor’s Recommendation
Approve
Deny
Explanation for the Recommendation
Complete only if Approved:
The Student should be limited to taking the following number of Credits this Semester
3 or less
4-6
7-9
10-12
I do not recommend a credit limit
Elements 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
Dea
n of Student Services Office
To be Completed by the Dean of Student Services
Appeal
Decision:
Appr
ove
Deny
Reco
mmendations:
Date
:
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Completed 25 July 2020

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