Request for Dismissal Administrative Review

Form Instructions:

Please fill out the following form to request an administrative review of your dismissal status. A review can be requested if there were late grade replacements submitted, late change of grades filed, or another substantial change was made to your record after academic standing was assigned for the term. You may submit the request up to 5 business days after receiving the dismissal notice. This not an appeal. If the administrative review is approved you will be placed on Notice of Dismissal.

10 Digit NSHE ID

If you are an Academic Advisor submitting this on behalf of a student, list the student's name below.

Please select from the following which academic action was taken:

If you selected other, please provide a brief statement below regarding the academic action that was processed.

Term (ex. Fall 2025)

Please list the class or classes the academic action was pertaining to (EX: MATH 126).

By initialing below you acknowledge you have read and understand the above statements.

Your name

Your email address

Verification Code

Request for Dismissal Administrative Review

Other Fields