CGCE Student Academic Appeal Form

College of Graduate and Continuing Education STUDENT ACADEMIC APPEAL PETITION FORM

First Name	*
Last Name	*
Student ID#	*
Email Address	*
Street Address	*
City	*
State (e.g. MA)	*
Zip Code	*
Home Phone	*
Cell Phone
Program of Study/Major	*
Undergraduate/Graduate	*


An appeal is a formal process. Appeal decisions will be made in accordance with University policy, where applicable. In case of course withdrawal, appeals are almost always denied if the issue is not the responsibility of University faculty, staff, or systems, or the result of documented extreme circumstances.

Please indicate which of the following policies you are appealing (check all that apply). Complete policy details are available on the Westfield State University website and the Westfield State University Catalog, in conjunction with other CGCE publications:
		Undergraduate Grade Appeal (Step One in Grade Appeal Policy must be completed) Graduate Grade Appeal Withdrawal from Courses Extension of Program of Study, Graduate Students only Other (please specify below)


What term does this appeal apply to:	*
What year does this appeal apply to:	*
What course or courses does this appeal apply to:

Please use the space below for a statement of justification explaining the grounds of your appeal. It is your responsibility to provide proof that your appeal is justified; incomplete or inaccurate information will result in denial of your appeal. Be specific – include course information and instructor (where appropriate), semester, dates, etc. In addition, wherever possible, attach below any documents validating your statement. Relevant emails may be copy/pasted into the field below or forwarded separately from this appeal form to jtansey@westfield.ma.edu. Any documents that cannot be attached electronically may be forwarded to Jessica Tansey, Director of CGCE, 577 Western Avenue, Westfield, MA 01086. For requests for extension of Program of Study, please provide an expected timeline of completion. Please be aware that all details in your statement will be verified.
	*
Attach additional documentation
Attach additional documentation
Attach additional documentation
	*	I hereby attest to the accuracy of the above statement. I understand that it is my responsibility to provide proof that my appeal is justified, and that incomplete or inaccurate information will result in denial of my appeal.
	*	I understand that this appeal may take up to one month to process, that all decisions are final, and that I will be notified of the outcome via the email address that I provided above.
Signature (Please type your full name here):	*