Disqualification Appeal Form

If you have been academically disqualified, use this form to apply for readmission to the university.

Name / Student I.D.#
Address / Street, Apt#, City, State, Zip
Best Phone / CSP Email / @csp.edu
Academic
Major or
Program / Proposed Semester of Return (highlight) / Fall
Spring
Summer / 2014 2017
2015 2018
2016 2019
Academic Advisor
Other institutions attended since leaving Concordia

Steps for submitting an appeal of your disqualification:

1)  Complete this Appeal Form and email it as an attachment to .

2)  Have letters of support from TWO individuals who can corroborate your hardship and speak to your potential for academic success emailed directly to .

a)  One letter must be from a Concordia University instructor

b)  No letter can be from a family member, friend, or fellow student

3)  Submit a personal statement explaining:

a)  What undue hardship caused your inability to meet satisfactory progress standards;

b)  Your plan for how you intend to be academically successful if readmitted.

Undue hardship may include, but is not limited to:

·  Death of an immediate family member. “Immediate” is defined as child, spouse, biological parent, or legal guardian

·  Serious and/or Significantly Limiting Health Impairment, defined as a health impairment lasting longer than 20% of the academic term or one that required hospitalization and was diagnosed by a professional care provider who is qualified to assess the student's functioning.

·  Other extenuating circumstances of relevant nature.

To comply with Title IV (federal financial aid) regulations, official documentation of extenuating circumstances (e.g. obituary, physician's letter, discharge plan, etc.) is required.

4)  If you have attended another institution since your dismissal, you must submit an official transcript of those credits to the Registrar before your appeal will be considered (),

5)  Email all appeal materials, including this form, at least 1 week before the first day of class of the term you would like to re-enroll in, to the Registrar’s Office - Disqualification Appeals Committee, at:

Email: Subject line: Disqualification Appeals Committee

All information concerning this appeal is confidential, retained in your file for documentation purposes only.

Revised 1/20/2016