College of Letters and Science
University of California, Santa Barbara
Division of Undergraduate Education
Appeal Questionnaire
_______________________________________________________________
______________________________
Name: print last name, first name, middle initial
perm number
____________________________________________________
_________________________
Local mailing address:
phone number
Street
Apt #
____________________________________________________
_________________________
City
U-mail address
State
Zip
GPA of last regular UCSB quarter attended: __________
Overall major GPA: __________
Cumulative UC GPA: __________
Upper-division major GPA: __________
If you are convinced that you are ready to succeed at UCSB this coming term, you may appeal for reinstatement by answering the
following questions. Please attach any supporting documentation to this form.
1. What are the causes of your academic difficulties? Please comment on your overall record, as well as the quarter that was the
most problematic.
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2. How have you resolved these difficulties?
3. What major do you plan to pursue? Have you met with the undergraduate advisor in your major department?
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4. Are you enrolled in a UC summer session? If so, which session(s) are you enrolled in?
4. When do you expect to graduate?
QTR_______ Year______
Signature: ___________________________________________________
Date: _______________
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