Jason Cifra, Vice Chancellor for Student Affairs

A student whose semester and cumulative GPA is below 2.0 at the end of a semester of academic probation or continued academic probation will be dismissed from the College. To file an appeal of Academic Dismissal, the following steps must be completed, within 10 working days of receiving the notification of academic dismissal:

1. Complete the front of this form and respond to the questions on the back. Attach additional sheets if you need more space. Also attach any documentation that supports your situation.

2. Mail (postmarked by) or email your appeal form, along with any supporting documentation by the deadline stated in your dismissal notice to:

Attn: Dismissal Appeal

200 W. Kawili St.

Hilo, HI 96720

3. You will be sent an email to your Hawaii.edu account with the final decision. If you are granted readmission you will be required to follow up with your Counselor for assistance with selecting appropriate courses and registration. An “Academic Advising” hold will be placed on your record which will require Counselor assistance to make registration changes throughout the course of the semester, until you are off academic probation.

Name:______ID#/MyUH Username:______

Mailing Address:______Phone:______

City:______St:______Zip:______Major:______

Email:______Cumulative GPA:______

Semester for which you were dismissed: FA SP Year:______

Are you receiving Financial Aid? Yes No

Are you receiving Veteran’s Benefits? Yes No

Are you on a F1 Student Visa? Yes No

OVER

A. Explain the extenuating circumstances that prevented you from being academically successful at Hawaii Community College. Be specific in explaining your situation. Extenuating circumstances may include, but are not limited to: personal injury or illness; family issues/difficulties; death of a relative, etc. In addition, provide any documentation you have to validate your situation.

B. Explain what has changed in your life that will now allow you to be academically successful.

C. Explain the strategies you will utilize that will allow you to be academically successful in future terms. Be specific and address strategies for each challenge you’ve identified above.

D. Are you receiving Financial Aid: YES NO If yes, please explain how you will be able to afford tuition since you may not be financial aid eligible upon being readmitted.

A student, who has been dismissed from the College for academic reasons and who did not appeal or whose appeal was not granted, may apply for readmission one year after the date of academic dismissal (Policy Haw 7.520).