Academic Appeal Form

First Name:

Last Name:

Semester / Year:

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 Success 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?

Please indicate if you would like to have New Hope Counseling Center staff involved in your appeal process. This means we can discuss your academic standing, financial standing, and disciplinary situations with the listed NHCC staff members.

I give permission for NHCC staff members to be involved in my appeal process.
YesNo

If yes, I give permission for the following NHCC staff members to be involved in my appeal process:

Draw your signature into the box below.

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