Program Dismissal Appeal: Student Information Form

Program *

Department *

Date of Dismissal *

Year Year20212022202320242025

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day Day12345678910111213141516171819202122232425262728293031

Statement from student *

Why do you believe you should not have been dismissed from the program? *

What is your understanding as to why you were dismissed from the program? *

What steps, if any, have you taken to resolve this dismissal prior to appealing to GAPDAC? *

Student contact information

Name *

Email *

Leave this field blank

Submit