Academic Appeal Request
Name and ID
First Name
Last Name
Student ID (Empower) Number
Contact Information
Email Address
Phone Number
Appeal Information
Program of Study
Please select...
Associate of Applied Science in Nursing
Associate of Applied Science in Radiologic Technology
Associate of Applied Science in Surgical Technology
Associate of Science in Health Sciences
Associate of Science in Health Information Technology
Bachelor of Science in Biology
Bachelor of Science in Healthcare Administration
Bachelor of Science in Medical Imaging
Bachelor of Science in Medical Laboratory Science
Bachelor of Science in Nursing
Master of Health Administration
Master of Science in Nursing
Certificate in Community Health Worker
Certificate in Computed Tomography
Certificate in EMT - Basic
Certificate in Imaging Quality and Safety
Certificate in Medical Coding
Certificate in Medical Resonance Imaging
Certificate in Paramedic
Certificate in Phlebotomy
Certificate in Polysomnographic Technology
Certificate in Mamography and Bone Densitometry
Graduate Certificate
Program of Study not listed
Semester
Please select...
Fall
Spring
Summer
Year
Appeal Type
Please select...
Academic Dismissal Appeal
Program Dismissal Appeal
Administrative Withdrawal/Refund
Other
Administrative Appeal Type
Please select...
Administrative Withdrawal
Refund Request
Administrative Withdrawal & Refund
Explanation of Your Request
Written Statement
Please attach a written statement explaining your request including a timeline of events and how you will manage the situation in future terms.
Supporting Documentation
Please attach any documentation that supports your request. This includes medical records, legal documents, traffic reports, employment records and/or any documents that verify your personal statement.
Mercy College of Ohio, a Catholic institution with a focus on healthcare, educates and inspires students to lead and serve in the global community.