APPEAL FORM
All students who wish to file a letter of appeal must complete this form, which includes your specific, detailed PLAN
FOR SUCCESS (second page). You may use additional sheets of paper. Letter of Appeal and Plan for Success must be
typed or neatly written (legible). This form is also available on the SUNY Delhi website:
http://www.delhi.edu/academics/provost/dismissal.php . If you send this form as an email file, you must use Microsoft
Word and email it to academicappeal@delhi.edu . If you do not have access to Microsoft Word on your computer, then
you must either fax your appeal, or hand deliver it. Students are encouraged to submit their letter of appeal using
email. There is no guarantee that your letter of appeal will be RECEIVED by the deadline if you send it via U.S.
Mail UNLESS you send it Express Mail with guaranteed overnight delivery (check with your local post office).
Confirmation that your appeal has been received
will be sent to your Delhi student email address.
APPEALS MUST BE SUBMITTED USING THIS FORM,
OR THEY WILL NOT BE CONSIDERED.
Name __________________________________
Student ID Number _________________________
(NOT Social Security Number)
Home Address (Street, City, State, Zip) ___________________________________________________________
Phone number where I can be reached on Monday, June 13, 2016:
_______
____________
Area Code Number
Advisor: _____________________________________ Major: ______________________
1.
Letter of Appeal (based on the Conditions of Appeal, which are enclosed with the letter accompanying this form)
(continued…)
2. Specific, Detailed Plan for Success.
List below the activities and initiatives you will take next semester to place you in good standing, if your appeal is
accepted. DESCRIBE SPECIFICALLY WHAT YOU WILL DO DIFFERENTLY TO ENSURE YOUR
ACADEMIC SUCCESS, if your appeal is accepted. The Committee reviewing your appeal will look closely at
the information you provide to see if you indeed have a plan to be successful, so BE SPECIFIC.)
_________________________________________
Signature (do not sign if you e-mail the form)
___________________________
Date
Name of Delhi faculty or staff member who can speak on your behalf:
________________________
Return this appeal letter in one of three ways:
Fax to:
607-746-4569
E-mail to:
academicappeal@delhi.edu (recommended method using your Delhi email address)
Mail to:
SUNY Delhi, Office of Records and Registration, 124 Bush Hall, Delhi, NY 13753
This form can be found online: http://www.delhi.edu/academics/provost/dismissal.php
Appeal must be RECEIVED by 3:30pm on Thursday, June 9, 2016
or it will not be considered.
Automated confirmation that your appeal has been received
will be sent to your Delhi student email address. Please ensure you entered your email address correctly.
HDAD/My Documents/Dismissals/Appeals Info/Appeal Form for Students