Appeal for Petition Denial

If you choose to file an appeal, this form must be submitted within 5 business days
from the date that you received the Denial Email.

Last Name:	First Name:
UID Number:
Telephone Number:	(please include area code)
UMD E-mail:
Major:
Primary/Departmental Advisor:	Phone:

I am appealing the outcome of a Petition for an Exception to Policy regarding ( select one):

	Enrolling for more than 18 credits
	Registering for a time conflict
	Repeat policy: enrolling in a course for a third time
	Repeat policy: exceeding the 18-credit repeat limit
	Drop more than four credits
	Late add/drop of a course
	Permission to take a course at another institution within the last 30 credits
	Other (please describe):

The date on which I was first notified of the decision I am appealing was:

Provide a detailed statement explaining the circumstances that led to this appeal request.

I will be submitting additional supporting documentation such as medical letters, transcripts, etc. to:
Appeals Committee.

Office Use Only:

Appeal approved:_______ Appeal denied: ________

Signature:________________________ Date:__________

Notes: ______________________________________________________________________________

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