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# Academic Appeals Form ACADEMIC BANKRUPTCY

Registrar Staff sign and date this form: ___

Signature                                      Date

Fill-In Information Below:



OFFICE OF

THE REGISTRAR

Phone: 502-597-6340

Fax: 502-507-6230

Student Name: ___ CWID: ___



Home Address: _____

Street          City          State          Zip

Home Phone: (____) _____ Advisor: _____

Fax: 502-597-6239

The Academic Appeals Committee can best contact me at the following address:

Local Address:___

Street ___ City ___ State ___ Zip ___ Phone ___

Term(s) for Academic Bankruptcy Request: ___

1.  Attach a letter from you. Write the committee a letter explaining  exactly what difficulty you experienced that led to your request for academic bankruptcy. Tell the committee why your appeal should be granted. All committee records are confidential. Be sure to sign your letter.

2.  Provide DOCUMENTATION: For example, if you had medical or legal difficulties, include something on official stationery from your doctor or lawyer. Letters on official stationery and or photocopies of official documents are best. In many cases, the committee  CANNOT grant your appeal unless you provide documentation to support your appeal.

3.  Letter from your advisor (optional): Ask your advisor to write a letter to support your appeal and send it to Dr. David Benders in Exum 226. If your advisor is not available, find your advisor's chairperson or dean and ask him/her to review your appeal. Although not required, such a letter may improve your chances of having your appeal granted.

4.  Turn in your completed form, letter, and documentation by the deadline: You must have not been enrolled at the University for a minimum of two years prior to declaring bankruptcy. This appeal  must be returned to the Office of the Registrar, Academic Services Building, Suite 323, Kentucky State University, Frankfort, KY, 40601. If you have questions please call (502) 597-6234. Fax number (502) 597-6239.

For complete directions and guidelines for appeals, please refer to the Academic Policies section of the latest edition of the KSU Catalog.