Exception Request

An Exception Request from Termination in SEVIS

A student slated to be terminated for poor attendance and/or grade point average due to extenuating circumstances may request for an exception from termination to continue his/her studies at POLY Languages Institute (POLY).  The exception request can be made only one time during his/her studies at POLY.  In order to be considered for such approval, 1) the student must be currently enrolled and 2) submit this form with applicable documents in a timely manner.

Within 7 days of submission, POLY Administration will review your petition and get back to you. Whether to approve your request or not, it will be at the sole discretion of the POLY Administration.

Name *

First

Last

Email *

Email

Confirm Email

Which School? *

• Poly Languages at Irvine
• Poly Languages at Los Angeles

State why your request for an exception should be made. *

Supporting Documents

Click or drag files to this area to upload. You can upload up to 3 files.

File extensions allowed: pdf, doc, docs. Maximum file size: 10 megabytes.

Credit Card Verification Fee *

Price: $1.00

The credit card information you provide will be used to identify the person completing this form. The cardholder’s name must match the name of the student. If you are using a credit card that’s not under your name, you must email us using the email account on your MyPOLY portal indicating the credit card holder’s name.

Stripe Credit Card *

Card

Name on Card

Submit