Academic Dismissal Appeal Form
Office of the Registrar 100 Grant Street, De Pere, WI 54115 (920) 403-3216
Submit this form either by:
FAX to 920-403-4047 or
E-Mail as an attachment to: email@example.com
Directions: Refer to the Satisfactory Academic Progress - Appeal Process and Procedures information sheet to assist in
understanding the dismissal appeals process. If you choose to appeal your dismissal, a written letter of appeal must be submitted by
the due date. To assist students with the appeal process and to help the committee in reviewing your situation you may choose to
complete this appeal form instead of submitting a letter. This form is designed to address the major areas of consideration of your
appeal. Some areas may not apply to your situation. After opening up this document, save it to your computer. Enter your name, and
then address any/all of the appeal questions presented using as much space as needed to completely and accurately answer the
question. When complete, save the document and either fax it to the number above or email it as an attachment to the email address
Student Name: ____________________________ Date Submitted: _________________________________
1. Appeals require a student to have experienced one or more mitigating circumstance that caused a failure to meet minimum
academic progress. Check which of the following mitigating circumstances you have experienced.
_____ Family difficulties, such as divorce or illness
_____ Death of a parent or relative
_____ Interpersonal problems with friends, roommates, significant others
_____ Difficulty balancing work, athletics, family responsibilities, etc.
_____ Financial difficulties
_____ Other: Indicate the issue here: _________________________________________________________________
Special note regarding health, wellness, and disability issues in considering academic appeals. SNC does not discriminate
against students with disabilities or wellness issues when reviewing academic appeals. Students eligible for disability services through
our Academic Support Services Office should address what changes if any may be needed in their use of accommodations
recommended by their licensed practitioner. Students with undocumented disabilities are expected to submit documentation and be
able to have a reasonable mitigation plan in place BEFORE the next semester begins.
Students with health and wellness issues are required to submit a statement demonstrating their readiness to return and meet the
expectations of the College. In addition, they will need to obtain medical verification from their outside mental-health-care provider
that they are capable of meeting our academic and co-curricular expectations upon returning to class and residing on campus. In these
cases, students are asked to address these issues in their appeals here, but will be referred to the College’s Health Services Offices to
submit confidential health and wellness verifications and to sign releases for our Health Services staff to discuss any submitted
verification with your provider, if necessary.
2. Explain specifically how the above circumstance impeded your ability to succeed academically. Address the issue(s)
chronologically – When did this happen? How did you respond to the situation? From whom did you seek assistance, council, or
advice? How did this situation affect you during the semester?
3. Address how you have remedied the situation so it will not continue to affect your future academic performance?
4. Are you currently enrolled in Summer Session either at SNC or at another college? _____ No _____ Yes
If yes, list the courses you are enrolled in.
5. Discuss your preregistered or planned selection of courses for the next semester. Address any plans you have to complete
foundational courses in math or English, repeat courses to improve your GPA, or plans to reduce your academic load.
6. What is your planned academic major? Based on your academic performance, do you feel this major still fits your interests and
academic abilities? If you are planning to change majors, what program(s) are you considering?
7. Students academically dismissed usually have GPA’s significantly below the required 2.00 GPA (overall and in one’s major)
required for graduation. What is your academic plan to get yourself back on track toward graduation? What is your plan for
future semesters beyond the next semester? When do you plan on graduating? Are you avoiding the tough courses within your
major? A detailed course plan for a least two semesters should be included.
8. What campus services did you utilize this past term to assist your academic performance? What services and support do you plan
to utilize if your appeal is approved?
9. Students who work more than 15 hours per week tend to have lower grades than other students. Do you work during the
semester? How many hours a week do you work? If you need to work more than 15 hours a week how do you plan to balance
life, work, and college responsibilities?
10. Have you had any campus conduct, infractions, or disciplinary issues that impacted your academic performance? If you have had
such issues, how have you addressed them? What do you think these issues indicate about your ability to live and learn at SNC?
11. Recommendations from parents, advisors, faculty, or other third parties are not required or asked for when considering appeals.
However, you may list any SNC individual whom you feel could verify, explain, or support any of your above answers should a
need for clarification arise. By listing the person(s) here, you are specifically approving the Academic Action Committee
members to discuss your situation as it pertains to your appeal. Again, this is strictly voluntary and does not require a response.
12. If there are other issues or circumstances that have not already addressed that you want to bring to the Committee’s attention,
please describe below.
Submission via email constitutes a valid signature. Please sign faxed appeals.