Appeal form for Public School Students

E 5128.00

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)
  • Statement
  • Transcript


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

Phone: 907-465-6535                                                 

Adopted 2/27/2013
Revised: 8/24/2016        


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