Academic Suspension Appeal Form - University Of Central Arkansas Page 2
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University of Central Arkansas
Academic Suspension Appeal Forms
Student Form
Instructions: Please fill out the form below and submit it with your documentation to the Registrar’s Office in McCastlain
Hall no later than seven (7) business days prior to the first day of classes of the semester in which you wish to enroll.
Last Name:
First Name:
Middle Initial:
Student ID #:
Cumulative GPA:
Credit hours completed:
Street Address:
City, State, Zip:
UCA E-Mail Address:
Other Active E-Mail:
Phone #: (
)
-
Major:
Major Advisor:
nd
rd
Current Suspension:
2
3
Have you Attended UCAN?
No
Yes
If yes, what semester? ____________
By submitting this form, I am indicating that the members of the AAA Committee will access and review my academic
record and supporting documentation to determine if there are mitigating circumstances that are sufficient to overturn my
academic suspension status. I understand that my appeal will not be considered until I have submitted all of the forms and
supporting documents as noted in the instructions above.
X
Student’s Signature
Date
By signing below, I am indicating I understand the AAA Committee Chair has a right to speak to my advisor and that my
advisor may appear before the Committee at my or the Committee’s request.
X
Student’s Signature
Date
By signing one (1) of the boxes below, I’m indicating my desire to appear or not to appear before the committee.
I wish to appear before the committee on the date my
I do not wish to appear before the committee and
appeal is reviewed. I understand that if I fail to appear, my
understand my documentation will be the sole
request will not be considered.
consideration for my appeal.
X
X
Student’s Signature
Date
Student’s Signature
Date
Petitions and supporting documentation must be received in the Registrar’s Office in McCastlain Hall at least seven (7)
business days prior to the first day of classes of the semester the student wishes to enroll. No appeal will be considered
until all forms and documentation has been received.
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