Academic Forgiveness Appeal Form
Southeast Technical is asking you to provide private information in order to process yourAcademic Forgiveness Appeal Form. This information will be used to update your academic record. You are not legally required to provide this information; however, the college may not be able to effectively process your request if you do not provide sufficient information. Access to this information will be limited to school officials, including faculty who have legitimate educational interests in the information. Under certain circumstances, federal and state laws authorize release of private information without your consent: to other schools in which you seek or intend to enroll, or are enrolled; to federal, state or local officials for purposes of program compliance, audit or evaluation; as appropriate in connection with your application for, or receipt of, financial aid; if the information is sought with a court order or subpoena; or as otherwise permitted by other state or federal law.
Section 1: To be completed by the student.
Student Name:
Student ID #:
Student Address:
Social Security #:
Email Address:
I understand the conditions outlined in the Academic Forgiveness Policy and request that my academic record be reviewed.
Signature:
Date:
(mm/dd/yy)
Section 2: To be completed by the Appeal Committee.
The student has qualified for academic forgiveness.
The student has not qualified for academic forgiveness.
Reason for not qualifying:
Signature:
Date:
(mm/dd/yy)
cc:
Student Advisor
Financial Aid
Student File
Revised 10-26-04 ta / 01-04-05 cs