COUNSELING DEPARTMENT: DISMISSAL APPEAL FORM

Deadline: Aug 18th, 2025

STOP!

If you were dismissed BEFORE Spring 2025, do NOT submit an appeal.

If you receive services through ACCESS (Accessibility Resource Centers for Students), would you like your appeal to be reviewed by ACCESS counselors if necessary? (optional)

(Must be typed): Explain your extenuating circumstances (e.g., illness, family emergency) and how it contributed to your dismissal. Include details and timelines regarding these circumstances for each term that you were on probation and continued probation leading to your dismissal. Explain the positive changes you have already made and/or plan to make to ensure your academic success (e.g., see a counselor, seek tutoring, reduce work hours, etc.).

Please include documents that provide evidence to support your statement. This information will be used to determine the appeal decision. All supporting documentation must have your name, ID number, and signature. All information submitted is confidential.