Appeal Form

Name*

First NameLast Name
Student ID Number*
Your student id number is a 7-digit number that can be located on your schedule, bill, transcript or MyDACC account.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Major*
Which semester(s) are you currently registered for?*

FallSpringSummerCurrently, not registered

Please state the reason(s) that you were unable to meet the standards of academic progress. *
Please be specific and concise.
Please explain what steps you have taken to ensure that you will be able to complete your classes if allowed to return and use Financial Aid. *
Please be detailed.
Initial below to acknowledge that you understand you must request a financial aid degree audit from your advisor if you are appealing a Max Time Frame status. Max Time Frame appeals will not be considered unless a degree audit is attached.*
Initial
Support Documentation
Other support documentation could include:
- A physician who can document that an illness or accident prevented the student from completing their studies and that the student is now able to successfully resume their studies.
- A physician/clergy/counselor who can verify that the death or life-threatening illness of an immediate family member prevented the student from completing their course work and the family circumstance is no longer applicable.
- An academic advisor/counselor, an employer, childcare provider, etc. who knows about circumstances beyond the student’s control that prevented the completion of course work and these circumstances have been resolved
Please upload any supporting documents for your appeal. Files must be readable (blurry documents will be rejected.)*

*Optional
Cancelof

The DACC appeals committee will meet to review written appeals at the end of each term. Students will be notified of the committee’s decision via email. The appeal committee’s decision is final.

If the student’s appeal is approved, they will be required to sign a SAP acceptance letter before financial aid can be disbursed to the student. This letter will state the conditions of the appeal. The student will again lose their SAP status if they do not meet the conditions of their appeal.

If the student’s appeal is denied, the student will remain ineligible for financial aid and will be responsible for any balance owed to the college.
Signature*

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Date*

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Date
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Support Documentation