RSCC –TN Education Lottery Scholarship (TELS)
Institutional Review Panel Appeal Form

 

This form must be submitted within 1 week of enrollment change and

WILL NOT BE ACCEPTED OR PROCESSED without documentation

 

Name _________________________________________ ID ___________________________

 

Phone No. _____________________ E-mail _________________________________________

 

Address ______________________________________________________________________

 

Please check one:

 

_____ Change from full-time to part-time and maintain my TELS award.

_____ Withdraw from RSCC and maintain my TELS award.

 

My request is due to:

_____ Illness of myself (doctor’s statement)

_____ Illness or death of an immediate family member (doctor’s statement or obituary)

_____ Extreme financial hardship of one of my family members (any substantiating documents)

_____ Military obligations of student or of immediate family member (activation letter)

_____ Other extraordinary circumstances beyond my control (any substantiating documents)

 

I understand that I will be notified within 14 calendar days after the appeal is delivered to the Financial Aid Office in Roane County for the IRP committee to review.

 

I understand that if the appeal is denied, I will receive all documentation and then may re-appeal to TSAC within 45 days:            TSAC

                                                %TELS Award Appeals Panel

                                                404 James Robertson Parkway, Suite 1950

                                                Nashville TN  37243

 

_______________________________________________________________  ______________

Student’s Signature                                                                                                       Date

 

FOR OFFICE USE ONLY

 

Approved _____ Denied _____ Signed _____________________________ Date ___________________

 

Reason for Denial _____________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________

 

Date student was notified ___________________ If denied, did notification include appeal option:  Y – N