Student Appeal Form

This form is to be used by students seeking a special waiver of Prairie State College policies due to extenuating circumstances. Please allow a minimum of three to four weeks to receive a written decision.

Please be sure to complete all sections to avoid a delay in processing.

PSC ID * Full Name * Home Street Address * Phone Number * PSC Email Address *

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Are you receiving financial aid? * Select an option:NoYes Degree Sought * Select an option:AAASAASAGSCertificateUndecided Which term are you appealing? * Select an option:FallSpringSummer What year corresponds to the term for your appeal? * If appealing a course, please list the course(s) you are appealing *

Please check the corresponding box of your explanation of appeal.

Explanation of Appeal *

Late Withdrawal (complete next question) Academic Forgiveness

Late Withdrawal Reason Select an option:1 = Financial2 = Medical (COVID-19 related)3 = Medical (other)4 = Course Concerns5 = Support Services Concerns (e.g., advising, business office, enrollment services)8 = Other Concerns Not Listed (complete next section) Brief Statement: *

Attach any documentation you have to support your request.

Supporting Documentation

 

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Additional Documentation

 

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I am verifying that I am attaching documentation for my appeal to be seriously reviewed. I have read the directions before submitting this appeal. * Student Signature *

Date: Friday, 26 April 2024 (EDT)

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