APPEAL FORM

All students who wish to file a letter of appeal must complete this form, which includes your specific, detailed PLAN FOR SUCCESS (second page). You may use additional sheets of paper. Letter of Appeal and Plan for Success must be typed or neatly written (legible). This form is also available on the SUNY Delhi website: . If you send this form as an email file, you must use Microsoft Word and email it to . If you do not have access to Microsoft Word on your computer, then you must either fax your appeal, or hand deliver it. Students are encouraged to submit their letter of appeal using email. There is no guarantee that your letter of appeal will be RECEIVED by the deadline if you send it via U.S. Mail UNLESS you send it Express Mail with guaranteed overnight delivery (check with your local post office).

APPEALS MUST BE SUBMITTED USING THIS FORM,

OR THEY WILL NOT BE CONSIDERED.

Name ______Student ID Number______

(NOT Social Security Number)

Home Address (Street, City, State, Zip) ______

Phone number where I can be reached on Friday, January 5, 2018______-______

Area CodeNumber

Advisor:______Major: ______

  1. Letter of Appeal (based on the Conditions of Appeal, which are enclosed with the letter accompanying this form)

(continued…)

  1. Specific, Detailed Plan for Success.

List below the activities and initiatives you will take next semester to place you in good standing, if your appeal is accepted. DESCRIBE SPECIFICALLY WHAT YOU WILL DO DIFFERENTLY TO ENSURE YOUR ACADEMIC SUCCESS, if your appeal is accepted. The Committee reviewing your appeal will look closely at the information you provide to see if you indeed have a plan to be successful, so BE SPECIFIC.)

______

Signature (do not sign if you e-mail the form)Date

Name of Delhi faculty or staff member who can speak on your behalf:______

Return this appeal letter in one of three ways:

Fax to:607-746-4569

E-mail to: (recommended method using your Delhi email address)

Mail to: SUNY Delhi, Office of Records and Registration, 124 Bush Hall, Delhi, NY 13753

This form can be found online:

Appeal must be RECEIVED by 4:00pm on Wednesday, January 3, 2018

or it will not be considered.

Automated confirmation that your appeal has been received

will be sent to your Delhi student email address. Please ensure you entered your email address correctly.

HDAD/My Documents/Dismissals/Appeals Info/Appeal Form for Students