[ { "page": 1, "items": [ { "page": 1, "type": "TITLE", "location": { "l": 135.36, "t": 762, "r": 476.16, "b": 738.72 }, "text": "KENTUCKY STATE UNIVERSITY", "reading_order": 0, "level": 1 }, { "page": 1, "type": "TEXT", "location": { "l": 216.72, "t": 731.04, "r": 394.56, "b": 713.04 }, "text": "Academic Appeals Form", "reading_order": 1 }, { "page": 1, "type": "TEXT", "location": { "l": 143.28, "t": 706.8, "r": 468.72, "b": 678.24 }, "text": "Office of the Registrar | Phone: 502-597-6340 | Fax: 502-597-6239\nDivision of Academic Affairs | Phone: 502-597-6234 | Fax: 502-597-6409", "reading_order": 2 }, { "page": 1, "type": "FIGURE", "location": { "l": 48.24, "t": 651.12, "r": 562.08, "b": 505.44 }, "text": "", "reading_order": 3 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 135, "t": 615, "r": 385, "b": 600 }, "text": "Student Name", "field_kind": "text", "label": "Student Name", "pdf_field_name": "student_name", "pdf_field_type": "Text", "reading_order": 4 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 440, "t": 615, "r": 560, "b": 600 }, "text": "CWID", "field_kind": "text", "label": "CWID", "pdf_field_name": "cwid", "pdf_field_type": "Text", "reading_order": 5 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 135, "t": 585, "r": 560, "b": 570 }, "text": "Home Address", "field_kind": "text", "label": "Home Address", "pdf_field_name": "address", "pdf_field_type": "Text", "reading_order": 6 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 135, "t": 555, "r": 335, "b": 540 }, "text": "City/State/Zip", "field_kind": "text", "label": "City/State/Zip", "pdf_field_name": "city_state_zip", "pdf_field_type": "Text", "reading_order": 7 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 395, "t": 555, "r": 560, "b": 540 }, "text": "Phone", "field_kind": "text", "label": "Phone", "pdf_field_name": "phone", "pdf_field_type": "Text", "reading_order": 8 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 90, "t": 525, "r": 335, "b": 510 }, "text": "Email", "field_kind": "text", "label": "Email", "pdf_field_name": "email", "pdf_field_type": "Text", "reading_order": 9 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 400, "t": 525, "r": 560, "b": 510 }, "text": "Advisor", "field_kind": "text", "label": "Advisor", "pdf_field_name": "advisor", "pdf_field_type": "Text", "reading_order": 10 }, { "page": 1, "type": "TEXT", "location": { "l": 59.04, "t": 485.52, "r": 302.88, "b": 469.92 }, "text": "Part 2: Type of Academic Standing Appeal", "reading_order": 11 }, { "page": 1, "type": "TEXT", "location": { "l": 47.76, "t": 453.84, "r": 339.84, "b": 437.52 }, "text": "☐ Academic Warning ☐ Academic Probation", "reading_order": 12 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 50, "t": 453, "r": 64, "b": 439 }, "text": "Academic Warning", "field_kind": "checkbox", "label": "Academic Warning", "pdf_field_name": "cb_warning", "pdf_field_type": "CheckBox", "value": "Off", "reading_order": 13 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 220, "t": 453, "r": 234, "b": 439 }, "text": "Academic Probation", "field_kind": "checkbox", "label": "Academic Probation", "pdf_field_name": "cb_probation", "pdf_field_type": "CheckBox", "value": "Off", "reading_order": 14 }, { "page": 1, "type": "TEXT", "location": { "l": 388.8, "t": 453.84, "r": 510, "b": 437.52 }, "text": "Academic Dismissal", "reading_order": 15 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 390, "t": 453, "r": 404, "b": 439 }, "text": "Academic Dismissal", "field_kind": "checkbox", "label": "Academic Dismissal", "pdf_field_name": "cb_dismissal", "pdf_field_type": "CheckBox", "value": "Off", "reading_order": 16 }, { "page": 1, "type": "TITLE", "location": { "l": 58.56, "t": 415.2, "r": 252.72, "b": 400.56 }, "text": "Part 3: Required Appeal Materials", "reading_order": 17, "level": 2 }, { "page": 1, "type": "TEXT", "location": { "l": 48.48, "t": 386.4, "r": 523.2, "b": 359.04 }, "text": "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.", "reading_order": 18 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 48.72, "t": 352.08, "r": 567.84, "b": 323.76 }, "text": "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.", "marker": "1.", "list_id": "L1", "level": 0, "reading_order": 19 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 47.52, "t": 321.6, "r": 559.92, "b": 308.4 }, "text": "Supporting Documentation (Required): Provide verified documentation (e.g., medical, legal) on official stationery.", "marker": "2.", "list_id": "L1", "level": 0, "reading_order": 20 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 47.04, "t": 306.48, "r": 554.64, "b": 279.12 }, "text": "Academic Improvement Plan: Required for Probation and Dismissal Appeals. Attach a structured recovery plan, proposed schedule, and strategy for meeting academic benchmarks.", "marker": "3.", "list_id": "L1", "level": 0, "reading_order": 21 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 50.16, "t": 277.44, "r": 604.32, "b": 245.28 }, "text": "Advisor Statement (Optional but Recommended): A letter of support from your Academic Advisor or their chairperson/dean.\nPart 4: Appeal Expectations & Requirements", "marker": "4.", "list_id": "L1", "level": 0, "reading_order": 22 }, { "page": 1, "type": "TEXT", "location": { "l": 48.24, "t": 227.04, "r": 144.96, "b": 213.84 }, "text": "Academic Warning:", "reading_order": 23 }, { "page": 1, "type": "TEXT", "location": { "l": 48.72, "t": 226.8, "r": 435.36, "b": 213.84 }, "text": "Demonstrate commitment to advising and academic support.", "reading_order": 24 }, { "page": 1, "type": "TEXT", "location": { "l": 68.4, "t": 211.2, "r": 469.44, "b": 199.2 }, "text": "demic Probation: Demonstrate ability to meet academic success plan requirements.", "reading_order": 25 }, { "page": 1, "type": "TEXT", "location": { "l": 47.76, "t": 196.08, "r": 580.8, "b": 184.08 }, "text": "Academic Dismissal: Demonstrate readiness to return, complete improvement plan, and comply with expectations.", "reading_order": 26 }, { "page": 1, "type": "TEXT", "location": { "l": 58.56, "t": 181.2, "r": 389.76, "b": 168.72 }, "text": "Requires participation in an Academic Appeals Committee Interview.", "reading_order": 27 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 200, "t": 160, "r": 350, "b": 145 }, "text": "Interview Date", "field_kind": "text", "label": "Interview Date", "pdf_field_name": "interview_date", "pdf_field_type": "Text", "reading_order": 28 }, { "page": 1, "type": "TEXT", "location": { "l": 47.76, "t": 156.96, "r": 190.32, "b": 144 }, "text": "Interview Date (if scheduled):", "reading_order": 29 }, { "page": 1, "type": "TITLE", "location": { "l": 59.04, "t": 125.04, "r": 333.12, "b": 110.64 }, "text": "Part 5: Submission & Student Acknowledgment", "reading_order": 30, "level": 2 }, { "page": 1, "type": "TEXT", "location": { "l": 47.28, "t": 91.68, "r": 552.24, "b": 63.6 }, "text": "Submit completed form, statement, and documentation to the Division of Academic Affairs, Hume Hall, Suite 202, or email to AcademicAffairs@kysu.edu.", "reading_order": 31 }, { "page": 1, "type": "TEXT", "location": { "l": 47.52, "t": 51.84, "r": 560.4, "b": 23.28 }, "text": "I certify that all information provided is accurate and complete. I understand that submission of this appeal does not guarantee approval.", "reading_order": 32 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 145, "t": 10, "r": 395, "b": -5 }, "text": "Student Signature", "field_kind": "text", "label": "Student Signature", "pdf_field_name": "student_signature", "pdf_field_type": "Text", "reading_order": 33 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 460, "t": 10, "r": 560, "b": -5 }, "text": "Date", "field_kind": "text", "label": "Date", "pdf_field_name": "date", "pdf_field_type": "Text", "reading_order": 34 }, { "page": 1, "type": "TITLE", "location": { "l": 48.48, "t": 6.96, "r": 139.44, "b": 0 }, "text": "Student Signature", "reading_order": 35, "level": 3 }, { "page": 1, "type": "TEXT", "location": { "l": 422.64, "t": 6.96, "r": 451.44, "b": 0 }, "text": "Date:", "reading_order": 36 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 135, "t": -42, "r": 235, "b": -57 }, "text": "Staff Initials", "field_kind": "text", "label": "Staff Initials", "pdf_field_name": "staff_initials", "pdf_field_type": "Text", "reading_order": 37 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 365, "t": -42, "r": 465, "b": -57 }, "text": "Date Received", "field_kind": "text", "label": "Date Received", "pdf_field_name": "date_received", "pdf_field_type": "Text", "reading_order": 38 } ] } ]