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KENTUCKY STATE UNIVERSITY

Academic Appeals Form

Office of the Registrar | Phone: 502-597-6340 | Fax: 502-597-6239 Division of Academic Affairs | Phone: 502-597-6234 | Fax: 502-597-6409

Part 2: Type of Academic Standing Appeal

☐ Academic Warning ☐ Academic Probation

Academic Warning

Academic Probation

Academic Dismissal

Part 3: Required Appeal Materials

Appeals of dismissal must be completed and submitted at least two (2) days prior to the first day of classes for the term for which the student is dismissed.

Personal Statement (Required): Write a letter explaining the academic challenges that led to your current standing. Detail specific steps you will take to improve performance, support resources you will utilize, and a rationale.

Supporting Documentation (Required): Provide verified documentation (e.g., medical, legal) on official stationery.

Academic Improvement Plan: Required for Probation and Dismissal Appeals. Attach a structured recovery plan, proposed schedule, and strategy for meeting academic benchmarks.

Advisor Statement (Optional but Recommended): A letter of support from your Academic Advisor or their chairperson/dean. Part 4: Appeal Expectations & Requirements

Academic Warning:

Demonstrate commitment to advising and academic support.

demic Probation: Demonstrate ability to meet academic success plan requirements.

Academic Dismissal: Demonstrate readiness to return, complete improvement plan, and comply with expectations.

Requires participation in an Academic Appeals Committee Interview.

Interview Date

Interview Date (if scheduled):

Part 5: Submission & Student Acknowledgment

Submit completed form, statement, and documentation to the Division of Academic Affairs, Hume Hall, Suite 202, or email to AcademicAffairs@kysu.edu.

I certify that all information provided is accurate and complete. I understand that submission of this appeal does not guarantee approval.

Student Signature

Date

Student Signature

Date:

Staff Initials

Date Received