Date Verified
Verified By
Required Documentation
Complete N/A
SEPC written recommendation
☐
☐
Program Director decision
☐
☐
Notice of Dismissal or other written decision delivered Registrar, Financial Aid, Student Accounts, and Dean notified
☐
☐
☐
☐
Clinical site(s) notified, if applicable
☐
☐
University appeal and outcome documented, if applicable
☐
☐
Record filed in secure student educational record ☐
☐
STUDENT ACKNOWLEDGMENT I acknowledge that I have been provided access to the NLU Master of Science in Physician Assistant Studies Student Dismissal Policy, that I have had the opportunity to ask questions about it, and that I understand that additional NLU University policies and procedures may apply.
Student Name: ______________________________________ Student Signature: ______________________________________ Date: ______________________________________
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