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INSTRUCTIONS FOR THE STUDENT
1. READ the following guidelines and follow these steps to determine your eligibility for a fee reduction before completing
this Appeal. Examples of extenuating circumstances for 3
rd
attempt fee reduction appeals include:
a. College Change: A letter from the appropriate college official documenting the situation in which the College initiated
an action that caused you to withdraw from your course(s).
b. Death of an immediate family member
c. Disability that impacts academic performance
d. Extended jury trial or direct involvement of the student in a current legal action (i.e. bankruptcy, divorce, etc.)
e. Involuntary call to active military duty
f. Involuntary job change, work schedule change or transfer
g. Serious illness / injury to the student or immediate family member
h. Other emergency circumstances or extraordinary situations (i.e. natural disaster)
Proof of the stated relationship (usually birth or marriage certificate) must be provided if you are submitting
supporting documentation pertaining to an immediate family member.
NOTE: The following circumstances are not considered extraordinary and extenuating, and are not
eligible for fee reductions:
incarceration; transportation issues; issues involving course content; issues involving method of instruction; issues involving a
lack of understanding of the College’s withdrawal / refund policy, or the instructor’s attendance / withdrawal / academic honesty
policy.
2. COMPLETE this Appeal Form.
3. TYPE AND SIGN a personal statement describing the situation and the reason(s) why you are requesting a fee reduction.
Be specific: indicate dates/time periods, names of individuals you spoke with and their Department(s), and how your
circumstances prohibited you from fulfilling the academic requirements of the course during your first two attempts. You
must include this in your Appeal package.
4. ATTACH
a. an approved
copy of your SMART Action Plan detailing your strategy for passing the course this time, AND
b. a current Academic Requirements Report (Degree Audit) or unofficial transcript, AND
c. a copy of your course schedule, reflecting registration for the course at an MDC Campus for the current term, AND
d. at least one of the following required and relevant supporting documents:
• A written statement on letterhead signed by a medical or mental health professional indicating the dates of any
services provided and the impact of this illness / emergency on your academic performance. If pregnancy or birth
of a child, copy of birth certificate and/or letter from physician must be provided.
• An official report of the occurrence such as a police report, divorce documents, insurance damage reports of
natural disasters, bills for services related to the emergency, court records.
• Copies of the deceased’s obituary, death certificate, official record or written statement signed by a credible
professional or clergy as well as proof of your relation to that individual.
• A written statement on official letterhead indicating involuntary work schedule change or transfer. Must state the
date the change took place and the working hours before and after the change.
• A written statement/form from the coordinator of the program servicing students with disabilities which affect
learning and academic performance.
Proof of the stated relationship (usually birth or marriage certificate) must be provided if you are submitting
supporting documentation pertaining to an immediate family member.
5. COPY the completed Appeal Form and documentation for your own records.
6. SUBMIT your original, completed Appeal packet to the Dean of Students’ Office by the 100% Refund date.
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