Academic Appeal Petition

Department of Athletics
(714) 278-2777 / Fax (714) 278-5396 

			
Student-Athlete (print or type)		SS#

Address		Sport

City	ST	Zip		Appealing:

		 2.0	Summer School Prior Approval
Telephone

Appeal Process
To be considered for continued eligibility based upon serious extenuating circumstances:
1.	Complete and submit this form for review to:  Director of Athletic Academic Services
2.	Attach all required documents
3.	Sign and Date
4.	Inform Head coach of petition and obtain signature
5.	Appeals will be reviewed by Academics Standards Subcommittee of the Athletics Advisory Council
6.	Student-Athlete will be notified in writing regarding disposition of appeal
7.	Student-Athlete will remain ineligible during appeal process

A.	Explanation of circumstances regarding academic ineligibility, include all details justifying petition:

	

	

B.	Attach an unofficial copy of grade report for both semesters (including summer school and/or intercession classes).
C.	Attach additional documents regarding the circumstances which would assist the committee in making a decision.
D.	Signatures:

	Student-Athlete		Date

				
	Head Coach		Date

Appeal Decision

Approved		Denied		Pending					
						Signature of Chair of Sub-Committee		Date	
Comments:	

Original:	Director of Athletic Academic Services
Copies:	(1) Student (2) Student File (3) Head Coach