APPEAL FOR TRANSFER-SUSPENSION ADMISSION

I am on academic suspension from __________________________________________________.

Name of institution

I am applying for admission to Delgado for the _______________________ of _____________.

semester year

I have read your transfer-suspension policy on the reverse side of this form.

I understand and accept the terms of enrollment at Delgado while I am on suspension. My signature on this form means I understand that I will be unable to transfer any credits earned at Delgado while I am on suspension. It also means I understand that if I am admitted and change my mind after I have registered, I am bound by Delgado policy regarding withdrawal procedures, grades and refund of fees.

I understand that if I am not an adult or emancipated minor, a parent or legal guardian must also sign this form.

___________________________________________  __________________________________

Name (Please Print)     Social Security #

___________________________________________________   Date: _____________________________

Signature              

___________________________________________  Date: _____________________________

Signature of parent or guardian (if required)            

________ Approved by Committee        Date: ____________________________

________ Denied            Date: ____________________________

________ Student Notified          Date: ____________________________

Form 1411/008 (12/94)

White-Records; Yellow-Student

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