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