Pandemic Related Appeal Form

This form is for students who are requesting specific consideration related to Cleary University moving to virtual support and online learning in response to a global pandemic. Specific considerations could include but are not limited to: family illness, employment, housing, food services, and travel.

Appeal Terms & Conditions

I understand that the information I provide will be reviewed by the Non-Academic Appeal board who will take any written statement, submitted documents and investigate university accessed information to make a determination.
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 appeals may take 10-15 business days for processing

Student ID #*
Student Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Class(es)*
Year*
Semester*
Description / Explaination from Student*
Please provide a clear explanation and justification for appeal in the space below. You may optionally provide additional justification 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 & Conditions

Pandemic Related Appeal Form

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