Academic Appeals Form
RETROACTIVE WITHDRAWAL
Registrar Staff sign and date this form: ___
Registrar Staff sign and date this form
Signature Date
Fill-In Information Below:
Inspiring Innovation.
Growing Leaders.
Advancing Kentucky.
Registrar Staff sign and date this form: ___
CWID:
Student Name:
THE REGISTRAR
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THE REGISTRAR Home Address
Street City State Zip
Home Phone: (___) ___ Advisor: ___
Phone: 502-597-6340
Home Address: ___
Fax: 502-597-6239
The Academic Appeals Committee can best contact me at the following address:
Local Address: ___
Street ___ City ___ State ___ Zip ___ Phone ___
Pick the type of Retroactive Withdrawal Sought:
_____Retroactive withdrawal from ALL course(s) for the _____term after the official deadline.
Pick the type of Retroactive Withdrawal Sought
Retroactive withdrawal from ALL course(s) for the
_Retroactive withdrawal from a course(s) after the official deadline
Retroactive withdrawal from a course(s) after the official deadline
List course numbers here:___
- Attach a letter from you. Write the committee a letter explaining exactly why you are appealing for retroactive withdrawal. Tell the committee why your appeal should be granted. All committee records are confidential. Be sure to sign your letter.
- 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. According to the catalog, the committee CANNOT grant your appeal unless you provide documentation to support your appeal.
- Letter from your advisor (optional): Ask your advisor to write a letter to support your appeal. 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. You may also want to ask your instructor(s) to write a letter in support of your appeal.
- Turn in your completed form, letter, and documentation by the deadline: two days before the next regular semester begins. 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.