Name: _______________________________________ Student Number:_______________
City, State, Zip:_______________________________________________________________
I authorize the members of the Intercollegiate Athletics Advisory Committee to review any or all materials pertaining to my academic record for the purpose of this appeal. In turn, the IAAC will maintain the confidentiality of the issue and the name of the individual involved.
AD Approval Signature:________________________Date: _____________
Describe the circumstances that have led to a cumulative grade point average of less than 2.0. You should address the following points:
(Continue on the back of this sheet if necessary.)