General Appeal Form

General Appeal Request Form

*Submission date of appeal must be no later than two (2) semesters after the semester in which you are appealing. *The Appeals Committee reviews all submissions monthly.
Date*

MonthDayYear
Date
Student LoLA ID#:*
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Term you are Appealing
ex. Fall 2021
Appeal Type*

Course Drop /Withdrawal RequestStudent Account Balance Adjustment
Reason for Appeal*
Share in chronological order, the detailed circumstances surrounding your request.
Supporting Documentation Upload

Cancelof
I acknowledge that I will be notified of the Appeals Committee decision by email within seven (7) days of review. And I may appeal the Committee decision in writing to the Associate Vice Chancellor of Student Services at CSAO@rpcc.edu within ten (10) of decision notification.

Clear
River Parishes Community College, a member of the Louisiana Community & Technical College System, accredited by the Southern Association of Colleges and Schools does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups.

The following persons located at 925 W. Edenborne Pkwy, Gonzales, LA have been designated to handle inquiries regarding the non-discrimination policies:Shalither Cushenberry– Section 504 Coordinator,Title IX Coordinator (225) 743-8500
River Parishes Community College does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities. **To contact individuals designated to handle inquiries regarding non-discrimination policies, click here.
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General Appeal Request Form