(TAP) SATISFACTORY ACADEMIC PROGRESS APPEAL FORM

Spring 2015 N.Y.S. (TAP) SATISFACTORY ACADEMIC PROGRESS
APPEAL FORM
STUDENT INFORMATION (Please Print)
____________________________________________________________________________________
Last Name
First Name
M
CUNYFirst EMPLID
____________________________________________________________________________________
Address (include apt. #)
City
State
Zip Code
____________________________________________________________________________________
Date of Birth
E -mail Address
Phone Number (with area code)
Instructions: Please answer all the questions on the back and attach documentation to support your
appeal (i.e.: medical statements, police reports, copy of death certificate, signed statement from objective
third party, etc.) AND please complete the Personal Statement.
Please note: Once you are placed on an academic plan AND your appeal is approved, you will be eligible
to receive New York State student aid provided that you meet all the terms and conditions of your
academic plan. If your appeal is denied, you will be not eligible for New York State student aid, such as the
TAP grant. You will need to seek alternative financial resources.
** Please be aware that submission of this appeal does not guarantee approval. All students are
responsible for their tuition and any fees regardless of their financial aid status.
DEADLINE:
April 1, 2015 (for the Spring 2015 Semester award)
I have read and understand the SAP requirements and the appeal process. I hereby attest that
everything I have recounted in this appeal is true and accurate to the best of my knowledge.
Signature: _____________________________________________ Date: ___________________
Please indicate the extenuating circumstances that contributed to your inability to maintain Satisfactory
Academic Progress by checking the category below that applies to you. Please follow the instructions for
each category. Attach copies of all documentation to support your request. If documentation is not
included your appeal will automatically be denied.
Medical
o Personal illness involving hospitalization or extended home confinement under a
physician’s supervision or illness of an immediate family member of which you were the
primary caretaker. Serious injury or illness to student or immediate family member
(spouse, child, sibling, or parent) that required extended recovery time. Attach a statement
from the physician and explain the nature and dates of the injury or illness. Evidence
(physician’s statement) of personal illness involving hospitalization or extended
confinement. If you are the primary caretaker and it required your absence from classes for
an extended period of time, include a statement from a physician, social worker, etc.
indicating your caretaking role.
Death-of an immediate family member
o Death of an immediate family member (spouse, child, sibling, or parent). Attach a copy of
the death certificate or obituary and include the name of the deceased and relationship to
you. You must provide copy of the death certificate during the time period and semester
affected.
Employment
o Change in student’s work schedule beyond student’s control, and upon which the student
and family are dependent. Submit a letter from an employer or unemployment records.
Military-duty
o Submit documentation of military service. Evidence (deployment orders) of military duty;
involvement with agencies or government; incarceration; or similar reasons that prevented
you from attending classes (official documents).
Significant trauma in student’s life
o Significant trauma in student’s life that damaged the student’s emotional and/or physical
health. Provide a detailed explanation regarding the specific circumstances. Please be sure
to include dates and what you have done to overcome this situation. Supporting
documentation from a third party (physician, social worker, psychiatrist, law enforcement
official, etc.) must be attached. Evidence (statement from a licensed physician,
psychologist, social worker, etc.) of an emotionally disabling condition that prevented you
from attending classes.
SAP APPEAL - PERSONAL STATEMENT
Date: ______________________
Name: ________________________________________________________________________________
Student CUNYFirst ID: _______________________________
Email Address:
_______________________________
Home Telephone: __________________________________Cell Phone#: ___________________________
Address: _______________________________________________________________________________
_______________________________________________________________________________
To:
Financial Aid TAP SAP Appeals Committee
EXPLAIN UNUSUAL CIRCUMSTANCE (in 250 words or less) Please type or PRINT legibly
Sincerely,
Signature
Date