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 Delgado’s transfer-suspension policy.
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) Student #
___________________________________________________ Date: _____________________________
Signature
___________________________________________ Date: _____________________________
Signature of parent or guardian (if required)
________ Approved by Committee Date: ____________________________
________ Denied Date: ____________________________
________ Student Notified Date: ____________________________
Form 1411/008 (2/07)