APPEAL FORM FOR DISMISSED NURSING STUDENTS

Students petitioning for return to a nursing program at Nicole Wertheim College of Nursing & Health Sciences must complete this appeal for consideration. Please include a statement explaining the reason for your petition in the space below, specifying the circumstances surrounding your academic challenge, and explain what has changed in these circumstances that will result in a favorable academic outcome.

Student Name Student Name First Last
Panther ID Number
Email
Last Semester Enrolled in Nursing courses:
Please select the applicable reason(s) for your appeal listed below and submit supporting documentation if applicable:

Please select the applicable reason(s) for your appeal listed below and submit supporting documentation if applicable: Medical Death in the Immediate Family (immediate family includes spouse, child, sibling, parent, or grandparent; must submit family member’s death certificate and appropriate documentation) Military Duty (must submit copy of military orders) Other Extenuating circumstances (please submit supporting documentation)
Statement of Explanation
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Date Date / MM / DD YYYY