Returning Scholarship Recipient
Appeal Form

Please complete all questions on the form below to submit an appeal for review.


Returning Scholarship Recipient Appeal Form

Date of Birth
Graduation Date
Are you in good academic standing to return to Jefferson or Simmons?
Please include any attachments that may support your appeal (doctor's note, transcript, etc.) This is not required.
Drop files here or
Accepted file types: pdf, doc, jpg, Max. file size: 50 MB.