===== PAGE 1 =====
# Academic Appeals Form RETROACTIVE WITHDRAWAL

Inspiring Innovation.

Growing Leaders.

Advancing Kentucky.

Registrar Staff sign and date this form: ___



Signature Date

Fill-In Information Below:

OFFICE OF

Student Name: ___ CWID: ___



THE REGISTRAR

Phone: 502-597-6340

Home Address: ___



Fax: 502-597-6239

Street City State Zip

Home Phone: (___) ___ Advisor: ___

## 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.

_Retroactive withdrawal from a course(s) after the official deadline

List course numbers here:___

1.  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.

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. According to the catalog, 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. 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.

4.  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.