Academic Bankruptcy Form

Petition for GPA Adjustment

First Name(Required)

Applicant's first name.

Last Name(Required)

Student #(Required)

Email Address(Required)

Phone Number(Required)

Authorization

I hereby request and authorize NW-SCC to apply Academic Bankruptcy to the following terms on my official transcript. Note: Student must have completed 12 semester credit hours of coursework at NW-SCC since the most recent semester for which the academic bankruptcy is requested. A grade of 'C' or higher is required in each course in the 12 semester credit hours in the post-bankruptcy period.

Term/Year1

Provide Term and Year for time frame desiring academic bankruptcy.

Term/Year2

Provide Term and Year for time frame desiring academic bankruptcy.

Term/Year3

Provide Term and Year for time frame desiring academic bankruptcy.

Statement of Agreement(Required)

I have read and understand the following statements: I understand in completing this form and checking the box above that Academic Bankruptcy may not benefit my Financial Aid record. I will consult with the Financial Aid Office on how this adjustment will affect my aid at NW-SCC. This adjustment request is solely for the purpose of potentially increasing my grade point average at NW-SCC.

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Enroll for the 2023 Summer or Fall Semesters.

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