SECTION II: REASON FOR APPEAL (Please check applicable circumstances.)

☐ Personal Illness or Injury - Supporting documents must include physician or attending professional citing illness and its probable effect upon student's academic performance. Include date of onset and length of time

Personal Illness or Injury -Supporting documents must include physician or attending professional citing illness and its probable effect upon

☐ Death of Immediate Family Member - Supporting documents must include obituary, death certificate, or letter from a professional lawyer, doctor, or minister, that states the date of the death and the individual's relationship to the student.

Death of Immediate Family Member -Supporting documents must include obituary, death certificate, or letter from a professional lawyer

☐ Other Unusual Circumstances - Supporting documents must include academic advisor, counselor, tutor, professor and/or professional who is familiar with the student's extenuating circumstances. Documentation must state the date/s during which these circumstances occurred and their probable effect on academic performance.

Other Unusual Circumstances -Supporting documents must include academic advisor, counselor, tutor, professor and/or professional who is

SECTION III: CERTIFICATION STATEMENT

  • By my signature below, I certify that I have read and understand Kentucky State University's (KSU) SAP Policy. I understand that it is my responsibility to monitor my academic progress and to be aware of the requirement of my program, so that I can complete my degree within the time allotted, the quantitative (GPA) and qualitative (completion rate) requirements in accordance with Federal regulations.
  • If my appeal is denied, I understand that I must reestablish my aid eligibility by attending at my own expense and raising my cumulative academic record to the minimums listed in the KSU student Financial Aid Satisfactory Academic Progress standards, and that I am responsible for any and all university charges incurred.
  • I further certify that the information in this appeal is accurate and complete. I understand that any false information will be cause for denial, reduction, and/or immediate repayment of any aid.

Student Signature

Date

SECTION IV: APPEAL COMMITTEE DECISION (to be completed by Office of Financial Aid)
☐ApprovedConditions/ Comments: ____________
☐Conditional Approval__________
☐Deferred__________
☐Denied__________
Term Approved: ☐ Fall/Spring ☐ Fall ___ ☐ Spring ___ ☐ Summer
☐ Additional Coursework☐ Medical (__________ documentation)
☐ Committee Exception☐ Professional Judgement
☐ Computer Error☐ Residence Credit (Grad Students)
☐ Grades/Change/Late☐ Other: Specify ____________
__________
SECTION IV: APPEAL COMMITTEE DECISION (to be completed by Office of Financial Aid)
Conditions/ Comments [1]
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Conditions/ Comments [2]
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Conditions/ Comments [3]
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Conditions/ Comments [4]
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Conditions/ Comments [5]
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☐Summer
Fall/Spring
Fall
Spring
Summer
documentation
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Medical
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Professional Judgement
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Residence Credit (Grad Students
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Other: Specify
[1]
[2]

Updated May 2025