Do not put in your full SSN. Only enter the last 4 digits.
Example of Types: AA, AAS, AS, CP, TC
Example of Types: Transfer, Nursing, Welding, Business (If you are not sure what your degree or major is please see Academic Advising before completing this form.)
*Explanation
Please provide a brief explanation for the following:
This field is required
PLEASE NOTE: There is no guarantee that your appeal will be approved. If your appeal is approved, you MUST comply with the following requirements:
I agree to the conditions listed above and I certify that all of the information provided on this form and any uploaded supporting documents are true, complete, and accurate to the best of my knowledge. I understand that typing my full name in this box constitutes a legal signature confirming that the Committee’s decision is final and cannot be appealed. I also understand that I will be placed on an Academic Plan.