Excelsior Scholarship Appeal Form

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The Excelsior Scholarship is the kind of program that gives tuition awards to every eligible student who is currently attending a public college and a university in New York State (SUNY or CUNY). This one, in the combination with some other student financial aid programs, gives a chance to every eligible student to attend SUNY (The State University of New York) or CUNY (The City University of New York) college for free without any tuition.

Talking about this scholarship and tuition, it is worth noting that the tuition only and does not cover the other costs of college. The statement means that the other college expenses such as fees, room and board, textbooks, and some other ones are excluded.

There are a lot of eligibility requirements to apply this Excelsior Scholarship. One of them is about the income. Basically, every student with the current income or prior year adjusted gross income of $125,000 or below due to the disability, divorce or separation of a parent, spouse or the student or the death of a parent or spouse has a chance to appeal their disqualification. Before anything, it is needed for the students to know what the Adjusted Gross Income is. For those who are not familiar with the Adjusted Gross Income or AGI, this one is able to be found on the federal income tax form. It refers to the total gross income minus the specific deductions. This kind of thing is determined by the income, the spouse and or parents where applicable.

If you are a student and you want to appeal your disqualification, you can fill out the Income Appeal Form. Here is the link that will take you to the form: HE9131A_-_Excelsior_Income_Appeal_Form_062019.pdf.  This form consists only of one page. In the first part of the form, you will have to provide some information about yourself such as your name (last, first, MI), your Social Student Number or SSN, and your date of birth.

After completing the first part, the next part that you have to complete is the basis of appeal. In this part, all that should be done is to check the basic for your appeal and then provide the documentation as indicated. For example, if the reason of you filling out this form is “Total and permanent physical or mental disability or a parent, spouse or applicant”, then you will need to provide a document called physician’s statement that includes certification that the disability is total and permanent and date parent, spouse or applicant became totally and permanently disabled.

Here is the detail of the Excelsior Scholarship appeal form:





You were recently notified of your ineligibility for the Excelsior Scholarship because your 2017

household federal adjusted gross income (AGI) is greater than $125,000. Applicants may use

their current income to establish income eligibility in the event of the disability, divorce or

separation of the applicant, parent or spouse or the death of a parent or spouse.

To appeal this decision, you must complete sections I and II of this form. Send the completed

form and all required documentation as instructed in sections II and III to:


*Please note that failure to provide all required information and documentation will result

in a denial of your appeal.


  1. Name (Last, First, MI):
  2. SSN (last four digits):
  3. Date of birth:


Check the basic for your appeal and provide the documentation as indicated.

Reason Required Documentation
Death of a parent or spouse Death Certificate and Statement of Relationship
Divorce of a parent of the applicant Divorce Decree
Separation of a parent of the applicant Separation Decree or Separation Agreement filed with the Court
Total and permanent physical or mental disability or a parent, spouse or applicant

Physician’s statement, including:

Certification that the disability is total and permanent

Date parent, spouse or applicant became totally and permanently disabled


Provide copies of the most recent W2 tax form(s), 1099 tax form(s) and NYS Tax Return(s) for the applicant and parent or spouse, as applicable.

Please provide every information and do not skip any. If you intentionally or unintentionally skip a part, there is a chance of your request to be denied. After completing the form, they can then send it through an email to NYSDREAMEXCELappeals@applyists.com. Before sending the form, do not forget to double check to make sure that everything is complete.

It should be easy for you to fill out the Excelsior Scholarship appeal form. In case you find some difficulties, the best thing that you can do is to reach out the contact number of SUNY or CUNY.


  • Phone number: 518.320.1100
  • Email address: communications@suny.edu
  • Address: SUNY System Administration H. Carl McCall SUNY Building 353 Broadway Albany, NY 12246


  • Phone number: 1-800-CUNY-YES (1-800-286-9937)
  • Email address: inquireCUNY@cuny.edu
  • Address: City University of New York University Offices 205 East 42nd Street New York, NY 10017

The most recommended way to reach them out is to call the phone number that has been mentioned above. By dialing the phone number, you have a high chance to get a fast response and it is definitely the best compared to the other two. In order to get the better response, you are encouraged to call the number on the work days and work time. The second one, which is sending an email is not recommended as it might take some time for them to give a reply. As for the third one, feel free to visit the address or to send a mail to the address. The latter one is not recommended, just like sending an email, as it might take some time for you to get a response.

For more information about the Excelsior Scholarship appeal form or Excelsior Scholarship in general, you are suggested to go to the official website of SUNY at www.suny.edu and or  the official website of CUNY at www.cuny.edu.

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