Scholar Tuition Rate Appeal Form
STUDENT INFORMATION (please print clearly)
First Name:
Last Name:
TSU Student ID: T
Email:
MI:
@my.tnstate.edu
For which semester are you appealing? Fall __________
Is this your first appeal? Yes__________ No ____________
If no, when was your previous appeal? __________________
Spring ____________
BASIS FOR APPEAL (please check one)
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□
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No Offer - I have met all requirements but the scholar rate is not reflected on my account.
Hours Earned - I received a grade of “W” or “I” in only one course during the previous semester. *
Graduation - I am a senior who will graduate this semester and require fewer than 15 hours to do so
(Written confirmation from my academic department head and/or advisor is attached).
CERITIFICATION STATEMENTS (Please read and initial each)
___ I certify that all information on this appeal form and supporting documentation is true.
___ I understand that loss of eligibility due to the Cumulative GPA cannot be appealed.
___ I understand that the Earned Hours Appeal may be granted once during my entire matriculation*
___ I understand that the submission of this appeal does not guarantee approval.
__________________________________________________________________________________
Student’s Signature
Date
Please submit this completed form and any supporting documentations to:
Enrollment Management and Student Support Services
Floyd Payne Campus Center Room 323
Email: [email protected]
Fax: (615) 963-2929
For Office Use Only
Request is:
*** Print SHATERM screen and attach to form. ***
Approved
Denied
Processed by: ________________________________________________________ Date: __________________
Comments: ___________________________________________________________________________________
SGASADD
SPACMNT
NOTIFICATION:
MyTSU EMAIL 