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 _________________________________________
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
Approved _____ Denied _____ Signed _____________________________ Date ___________________
Reason for Denial _____________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________
Date student was notified ___________________ If denied, did notification include appeal option: Y – N