STEP 1: Contact the Advising Center to meet with an advisor to complete this form and to review your situation and identify
the required documentation. 763-424-0703.
Advisor Signature: Date:
P 2: Identify the semester, type of request and classes to be reviewed:
Summer 20____ Fall 20____ Spring 20____
Late Withdraw Tuition Refund
STEP 3: Rationale for appeal and required documentation. Appeals without relevant documentation will be denied.
Major Medical Issue – an unexpected, significant medical condition prevented attendance.
Healthcare provider statement (signed and written on letterhead) that clearly identifies the dates
and the situation that prevented you from attending classes. Do not provide copies of bills,
appointments, prescriptions, etc.
College materials documenting the error or an employee written statement describing the
Military Call to Active Duty (a late drop may be requested if due to military call-up to active duty)
Copy of DD-214
Documentation that supports your request and that the circumstances were unforeseen and
beyond your control or choice.
P 4: Provide a written statement (one page maximum) describing the situation in detail.
P 5: Read and sign below:
I have read and understand:
Late withdrawals can result in aid recipients being required to repay financial aid for the semester.
The appeal deadline is 30 days after the appeal term ended.
Appeal results will be emailed to the email address above within 14 business days.
Requests based on the following situations will not be considered:
o Lack of knowledge of drop, refund,
withdrawal or other college policies
o Dissatisfaction with faculty, class or grade
o Voluntary acceptance of employment or
other activity impacting ability to attend
o Disregarding course/placement requirements
o Change in marital or relationship status
o Did not attend course(s)
o Incarceration or arrest
o Inability to pay
Student Signature: Date:
STEP 6: Return this form and the required documentation to the Advising Center, ES-69
Questions? Call Advising at 763-424-0703 or email firstname.lastname@example.org
7411 85th Avenue North • Brooklyn Park, MN 55445 • Phone: 763-424-0702 • Fax: 763-424-0929 • Email: email@example.com • Web: www.nhcc.edu
Member of the Minnesota State Colleges and Universities System and Equal Opportunity Educator and Employer
For disability accommodations call 763-493-0555, Minnesota Relay users may call 1-800-627-3529