First Name:

Last Name:

Semester & Year you would like to attend:

Satisfactory Academic Progress is the minimum standard ACC has established for you to complete your studies and continue to receive federal financial aid. You will need to develop an academic plan with the Student Engagement Center and complete this appeal form.

Which of the statements below best describes a situation that affected your academic progress this semester? You must choose at least one.
Death in the familyDeath of a close friendFamily emergencyMedical issue (such as a broken bone or surgery)Victim of a crimeWithdrew from classes earlyStudent Life suspension/dismissalOther

If you selected "Other" above, please provide a detailed explanation of the situation.

What happened this semester that led to your current GPA/pace?

In the space below, please explain what changes you plan to make to achieve Satisfactory Academic Progress?

Participation in counseling sessions at New Hope Counseling Center may be a requirement of the Academic Learning Plan developed in coordination with the Student Engagement Center.

I agree to attend sessions at NHCC if required by my Academic Learning Plan.
YesNo

Draw your signature into the box below.

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