Appeal for Exception to College Policy

Appeal for Exception to College Policy

Academic Appeal
Middlesex College ID Number*
Date*

MonthDayYear
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Middlesex College Email Address*
example@example.com
Personal Email Address
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
What semester are you appealing?*
ex: Fall 2024
Program of Study*
Are you a veteran?*

YesNo
Do you receive financial aid?*

YesNo

Submission Requirements and Information
Students may file a written appeal for an exception to academic policy by submitting a completed Appeal for Exception to College Policy form. The request will be reviewed by the appropriate College Office/Academic Division and the student will be notified of a decision through their Middlesex College email account. Students should review the Submission Requirements and Information for guidelines on Academic Appeal submission.
- Read the Academic Appeal “Submission Requirements and Information”.
- Attach documentation, if appropriate, that supports your appeal (medical documentation, police reports, etc.).
- If a non-academic (financial) request is also associated with the academic appeal, a separate Appeal for Exception to College Policy – Tuition Appeal must be submitted subject to the policies/procedures of Tuition Appeals.
- Maintain copies of all documentation submitted for your records.
- Appeals are generally reviewed and decisions made within 10 business days of receipt. If consultation with Chairperson, instructors or other College officials is required, it may extend longer.
- You will be notified through your Middlesex College email of the decision.
Note: Appeals for a Grade Change or Retroactive Withdrawal from a Course Must be Received within One Year of the end of the semester for which the appeal is being submitted.

Note 2: Students seeking to request Academic Amnesty need to meet the criteria outlined: Academic Amnesty Appeal

[END] Submission Requirements and Information

Academic Appeal Request
Reason you are submitting an appeal:*

I am requesting to repeat a courseI am requesting a credit overloadI am requesting a grade changeI am requesting a change of academic statusI am requesting to withdraw from a course(s)I am requesting a change to my Program Catalog YearI am requesting Academic AmnestyOther
Reason you are submitting an appeal: (Other)*
Note: Appeals for a Grade Change or Retroactive Withdrawal from a Course Must be Received within One Year of the end of the semester for which the appeal is being submitted.
Course(s) being appealed:*
One course per line
Describe why your academic appeal warrants an exception to College Policy:*
Indicate the Academic Program and Catalog Year you wish to change to, along with the reason for your request in “Additional Comments/Information”.
Additional Comments/Information
Documentation Supporting Academic Appeal

Browse Files

Cancelof

[END] Academic Appeal Request

Academic Appeal Statement of Understanding
I understand that the academic appeal may not be reviewed or denied if my appeal is incomplete, lacks supporting documentation, or is submitted beyond the required deadline. The decision of the College is final.
Academic Appeal Statement of Understanding*

I agree
Student’s Signature*

[END] Academic Appeal Statement of Understanding
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