Graduate Request for Academic Clemency
Banner ID:
Student Name:
Graduate Program:
Matriculation Term/Year:
Graduate Academic Clemency provides an opportunity to help you achieve good academic standing at the College. Please
review the following link for policy details http://www.brockport.edu/policies/docs/graduate_academic_clemency.pdf.
Select the option that best describes your student status:
Previously Dematriculated (must not have taken courses at Brockport for at least 2 calendar years)
Newly Matriculated (seeking clemency for non-matriculated coursework)
Currently Matriculated
Current Probation Status (check one): Probation I
Probation II
Graduate academic clemency can be granted only one time for up to 9 credits of graduate coursework. Only
enough course grades stricken from the cumulative graduate GPA to return the student to good academic
standing (GPA 3.0) is permissible. Clemency is requested for the following coursework:
Course Name/Course Number
Semsester/Year
Course was taken
Number of
Credits
Grade
Earned
Course Fulfilled
Degree
Requirement? Y/N
Current Brockport
GPA:
Brockport GPA after
Clemency:
Explanation of Circumstances Leading to Clemency Appeal:
Student Signature
Department Graduate Director Signature
Dean of The Graduate School Signature
Date
Date
Department Chair Signature
Date
Date
Office Use Only: Confirmation Email Sent to Student/Department:_____ Hold Release Date______Probation Release Date_____
Prior Requst:______ Registration and Records Process Date: _________