Non-Academic Appeal Form

Appeal Terms and Conditions:

I understand that all communication, including the outcome of the appeal board’s decision, will be sent via email to my Cleary email address.

I understand that any misrepresentation of the facts can result in formal disciplinary action

I understand that incomplete appeals will be denied.

I understand appeals must meet the criteria as described on next page and include supporting

documentation.

I understand appeals may take 10-15 business days for processing.

Student ID #*
Student Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Phone*
Note: By providing a phone number I consent to Cleary leaving messages (voicemail, text messages and/or verbal messages with any person who answers at the number) with specific information related to Cleary (course enrollment, appointments, advising, financial aid, payments, admission, etc.)
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Expected Outcomes
Check the box(es) indicating the specific outcomes you are expecting.
- Withdraw
Withdrawal Class(es)
Withdrawal Year / Semester
- Withdraw with Exception
Withdrawal with Exception Class(es)
Withdrawal with Exception Year / Semester
- Adjusted Bill
Adjusted Bill Class(es)
Adjusted Bill Year / Semester
Reason for Appeal
Check the applicable situation and note documenation requirements below.
Required: Obituary or death certificate which includes your relationship to the deceased.
- Death of an immediate family member (spouse, child, parent, sibling or legal guardian of the student).
Required: Obituary or death certificate which includes your relationship to the deceased.
Required: Your employer must provide a letter of support on official company letterhead specifying exactly how your change in work interferes with your ability to attend class. The letter must be signed by your supervisor or higher company manager. Students must make every effort to find options to complete the semester before an exception is considered
- Return to work (from a lay-off)/change in working hours that occurred after the semester began and that substantially interferes with your ability to attend class *Starting/Accepting a new job is not applicable.
Required: Your employer must provide a letter of support on official company letterhead specifying exactly how your change in work interferes with your ability to attend class. The letter must be signed by your supervisor or higher company manager. Students must make every effort to find options to complete the semester before an exception is considered
Required: The statement must be on the physician’s letterhead and include expected start and end dates of the medical condition. The doctor must verify in the statement that you cannot attend any class as the medical condition is very serious and prevents you from participation in employment, education, and other major life activities for the duration of the semester.
- Medical: Provide a doctor’s letter that states your condition or injury prevents you from completing classes.
Required: The statement must be on the physician’s letterhead and include expected start and end dates of the medical condition. The doctor must verify in the statement that you cannot attend any class as the medical condition is very serious and prevents you from participation in employment, education, and other major life activities for the duration of the semester.
Required: Submit a copy of your military orders with dates.
- Call to military duty. *Voluntary enlistment and subsequent call to duty during enrolled semester of appeal not applicable. *
Required: Submit a copy of your military orders with dates.
Required: Submit documentation that verifies how the situation inhibited your ability to attend and participate in class (i.e. court documentation, accident report, doctor’s note)
- Other Extenuating Circumstances (i.e. auto accident, court proceedings, family illness)
Required: Submit documentation that verifies how the situation inhibited your ability to attend and participate in class (i.e. court documentation, accident report, doctor’s note)
Required: Submit documentation that clearly supports how you have met the grounds for appeal as outlined in your Cleary University Judicial Board Sanction Letter
- Judicial Appeal: You received a Judicial Sanction from the Cleary University Judicial Board.
Required: Submit documentation that clearly supports how you have met the grounds for appeal as outlined in your Cleary University Judicial Board Sanction Letter
Description / Explaination from Student*
Please provide a clear explanation and justification for appeal in the space below. You may optionally add more explaination by uploading a document below.
Supporting Documentation
Additional documentation is not required but can support your case. Examples of relevant documentation could include medical documentation, obituaries, email communication with faculty and staff, or job related documentation. (10MB limit)
Drop files here or

Max. file size: 10 MB.

Appeal Terms and Conditions:

Non-Academic Appeal Form

Expected Outcomes

Reason for Appeal

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