Appeal form for Public School Students
Appeal Form for Public School Students
AS 14.03.113. District determination of scholarship eligibility.
A district shall provide a student with an opportunity to request that the district correct an error in the eligibility determination.
The following information is required for the school district to evaluate your appeal to receive an APS scholarship. Complete this form and return it to your school district. Please print to ensure information is legible.
Last name First Name M.I. DOB
Permanent Mailing Address City State
Zip Home Phone Cell Phone Email
Did you meet the minimum test scores of ACT 21 or SAT 1450, or WorkKeys Level 13 (no score below a 4 in each subject area)? Yes No
My ACT score is My SAT score is My WorkKeys score is My GPA is
Did you meet the course requirements for your class year? Yes______ No______
Were your requirements met by high school graduation? Yes No
Provide a concise statement identifying the reasons supporting a reversal or modification of the school district’s eligibility determination. Note: Failure to meet APS requirements for reasons other than those allowed for under the statutes and regulations governing the APS does not entitle the applicant to a reversal or modification of eligibility. You may use a separate sheet of paper. Provide documents, papers, or other materials that support a reversal or modification of the district’s eligibility determination. This must include:
- ACT and/or SAT score report (s) (an official copy from the ACT/SAT)
- WorkKeys score (if taken outside of the school district)
Student Signature Date
School District Review and Signature Date
School District should submit this signature page and record change to:
If you are unable to contact your school district office, you may contact:
Shari Paul, APS Program Coordinator
Alaska Department of Education and Early Development
P.O. Box 110500 Juneau, Alaska 99811-0500
KETCHIKAN GATEWAY BOROUGH SCHOOL DISTRICT