Academic Disqualification Status Appeal Form

Before completing this online form

Carefully review Cal Poly’s Academic Probation and Disqualification Policy.
Reflect on the circumstances that have contributed to your academic disqualification status.
Type your appeal and success plan in a separate document first, then cut and paste it into the appropriate sections below.
Have all supporting documents (if applicable and available) ready in PDF format labeled EXACTLY as shown. CalPolyUsername_major_DocName.pdf (EX: cpmusty1_psyc_DrNote.pdf).
Review academic probation support page to learn about resources, how to calculate GPA, explanation of policy.
Reference other resources if needed:

Basis for Appeal

Students in disqualification status are encouraged to submit a written appeal to explain any extenuating circumstances, including personal hardship, that have impeded their ability to succeed academically. Appeals may include additional documentation that provides support verifying these circumstances (i.e., a note from doctor or counselor, medical statements, financial statements, etc.). If you plan to appeal, please submit by the deadline even if you do not yet have related documentation.

Once submitted, this appeal packet and supporting documentation become property of Cal Poly.

Appeal is due no later than 5:00 p.m., Wednesday, June 25, 2025. You will be notified via your Cal Poly email address of the final decision by 5:00 p.m. Friday, June 30, 2025.

Appeal for Reinstatement after Disqualification Status Form

Student Name *

Cal Poly Email Address *

College *

CAED Majors *

CAFES Majors *

CENG Majors *

CLA Majors *

OCOB Majors *

BCSM Majors *

Term GPA *

CPSLO GPA *

Higher Education GPA *

I am appealing for reinstatement for *

Appeal Statement

Appeals should be no more than 750 words, addressing the following: Explain the extenuating circumstances you faced and how these circumstances negatively impacted your academic performance. Explain how you will develop a plan for future success that directly addresses these circumstances and includes specific actions you will take, academic strategies you plan to implement, and how you will seek out support in order to return to good academic standing.

Statement *

Success Plan

This is an outline of specific steps you will take to ensure future academic success. The success plan should include: • Calculation of your major GPA. • Review planned courses in Degree Planner, including any repeat courses needed to improve your academic standing. • If employed or planning to be employed, your work schedule and number of work hours per week. • Study strategies you plan to implement. • Campus resources you plan to utilize. • If you need help with any of these tools listed above, please reference the links at the top of the page.

Outline *

Supporting Documents

If applicable, submit PDF documents with the document name formatted as follows: CalPolyUsername_Major_DocName.pdf (example cpmusty1_psyc_DrNote.pdf)

Documents

Files must be less than 4 MB.
Allowed file types: pdf.

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Academic Disqualification Status Appeal Form

Before completing this online form

Basis for Appeal

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