Academic Separation Appeal Form
Student Services Office | 309.341.5237 | studentservices@sandburg.edu
This form is used to appeal your academic separation from Sandburg. If you need to appeal for financial aid, please use this form: https://sandburg.jotform.com/210686294933868
Name
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First Name
Last Name
Email
*
example@example.com
Student ID#
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Semester you would like to return to Sandburg:
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What is your current degree or certificate objective?
*
Please provide a detailed response to the questions below.
1. What extenuating circumstances prohibited you from meeting the Satisfactory Academic Progress requirements? Documentation to support your appeal is recommended. (Example:letter confirming medical treatment, confirmation of death in the immediate family,etc.). Please attach these documents to the file uploader below.
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2. What changes have occurred that will enable you to meet the Satisfactory Academic Progress requirements in the future? Please explain in detail.
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I certify the information provided above is true and complete.
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Signature
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Date
*
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Month
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Day
Year
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