Academic Standing Appeals Form - Sowela Technical Community College (Page 2 of 2) in pdf

Academic Standing Appeals Form - Sowela Technical Community College Page 2

Office o f A cademic A ffairs

Administrative S uites

3820 J . B ennett J ohnston A ve.

Lake C harles, L A 7 0615

Office: 4 21-‐6570/Fax: 4 91-‐2443

Academic Standing Appeals Form

Confidential

Student Name____________________________ Student ID#

______________________

Telephone_____________________________

Email address_______________________

Address_____________________________________________________________________

Program__________________________________ Department ________________________

Clearly state the problem (Attach additional paperwork if necessary)

____________________________________________________________________________

What specific action do you request? (Attach additional paperwork if necessary)

____________________________________________________________________________

I CERTIFY THAT ALL INFORMATION RECORDED ABOVE IS CORRECT.

Student Signature: _______________________________

Date:_______________________

DO NOT WRITE BELOW THIS LINE

Approved

Notes: _____________________________________

Approved with Conditions

___________________________________________

Pending Additional Documentation

___________________________________________

Denied

___________________________________________

Committee Chair Signature: _____________________________ Date:___________________

Academic Standing Appeals Form - Sowela Technical Community College Page 2