Fillable ACADEMIC AND REFUND APPEAL FORM Kellogg Community College (Kellogg Community College)

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ACADEMIC AND REFUND APPEAL FORM Kellogg Community College (Kellogg Community College)

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Kellogg Community College policies on refund appeals and academic (grade) appeals are found in the KCC
Catalog and Student Handbook.
The college realizes that, on rare occasions, students may need to appeal due to extenuation circumstances such as:
• Your induction into or deployment for services in the U.S. military
• Death of an immediate family member (parent, child, spouse, life partner, sibling or grandparent)
• A documented medical emergency, including a one-time appeal based on a documented health condition
In all cases, the situation must have disrupted your ability to:
• Attend class(es) for a substantial length of time
• Complete the course requirements
• Adhere to the standard withdrawal or refund procedures
Examples of reasons not accepted for an appeal are:
• Incarceration
• Academic disputes between the student and the instructor (see Division Chair person)
• Unaware of refund/withdrawal deadlines
• Lack of meeting course prerequisites
• Loss of transportation to/from class
• Lack of your communication with the instructor
• Disabilities not ocially led with the Support Services Oce or failure to observe the guidelines provided for
academic success
• Disciplinary action
• Late registration/inability to perform in the classroom
• Unexcused absences
• Acceptance into another school
The appeal form must be accompanied by:
• A typed statement from you, the student, which details the basis of the appeal
• How the occurrence aected your ability to complete course(s), and the outcome you seek in the appeal
• Supporting documentation must also be included on any appeal
Note: An appeal written on behalf of a student (i.e. parent, counselor, doctor, etc.), even with the student signature, will
not be considered.
ACADEMIC AND REFUND
APPEAL FORM
Oce of the Registrar
450NorthAvenue•BattleCreek,MI49017-3397
(269)965-4150•fax(269)565.2048
www.kellogg.edu
10/12
Office of the Registrar
450 North Avenue • Battle Creek, MI 49017-3397
(269) 965-4150 • fax (269)565.2048
www.kellogg.edu
Instructions for Submitting an Academic or Refund Appeal
• An academic appeal must be submitted within one year of the date when the grade was assigned. Questions
regarding the receipt of a nal grade should be directed to the instructor. If a satisfactory solution is not received,
you are to discuss your concern with the chair person, director, or the department dean of the division prior
to submission of an academic appeal.
• A refund appeal must be submitted within one year of occurrence.
• You must withdraw, or be administratively withdrawn from the class(es) for which you are submitting the
refund appeal. No action will be taken if the course withdrawal has not been completed.
• No adjustment will be made if you were withdrawn from any course for disciplinary reasons.
• The appeal will be considered in a timely manner and you will be notied of the decision via regular mail at the
address on le with the college. It is your responsibility to ensure the college has your most current address on le.
• All supporting documentation must be attached for consideration.
• The responsibility for ensuring that the college has received the needed documentation rests with you.
• If your refund appeal is granted and you are a nancial aid recipient, including student loans, your nancial
aid may be reduced or removed and could result in a return of funds to the federal government. You will
be responsible for repaying those funds immediately. This includes any nancial aid refunds that you have
received and/or bookstore charges. You should discuss the impact of the appeal with the Financial Aid
Oce before submission.
• Filing a refund appeal does not relieve your current obligation to the college. You are responsible for all
charges assessed on your account pending a decision on your appeal.
10/12
ACADEMIC AND REFUND
APPEAL FORM
Academic and Refund Appeal Form
• Complete these forms and submit them to the Records/Registration Oce or Regional Center
• Besuretoincludeappropriatedocumentation
Appeal is for the following semester and year: Fall of Spring Summer
Please list the course(s) you are appealing:
CourseNumber(exampleACCO*101)CourseTitle(GeneralAccounting)NumberofCredits(4credits)
Check Reason for Appeal
 U.S.MilitaryInduction/Deployment:submittheinduction/deploymentnoticethatclearlydisplaysthedateofinduction/
deployment
Death of an immediate family member (parent, child, spouse, life partner, sibling or grandparent): submit a death certicate,
obituary, or death notice. If the documents do not clearly indicate the relationship of the deceased to you, please supply
document(s) that do indicate the relationship.
 Adocumentedmedicalemergency:submitstatementfromaDoctor,orMedicalFacility(includingphonenumber),
dated and signed. The statement must indicate that the medical situation is preventing you from attending class(es) for a
substantial length of time, completing the semester, and/or prevented you from adhering to the usual withdrawal or refund
procedures. The college reserves the right to verify the authenticity of submitted documentation.
Other: provide a detailed explanation of the circumstances and include documentation such as legal documents, police
reports,etc.Pleasereviewnon-acceptablereasonsonpage1.
 Gradeappeal,Iwasunabletondasatisfactorysolutionregardingthegradeissuedbymyinstructor.Ihavehad
conversations with the chair/director and dean and did not nd a satisfactory solution.
First Last
Street
City State Zip Code
Oce of the Registrar
450NorthAvenue•BattleCreek,MI49017-3397
(269)965-4150•fax(269)565.2048
www.kellogg.edu
10/12
KCC ID Number
Phone Number
ACADEMIC AND REFUND
APPEAL FORM
Checking each box below veries that I have read, understand, and will follow each guideline:
I acknowledge that I have withdrawn or received an administrative withdrawal from the class(es) listed above.
Attached is a letter of explanation and the supporting documentation. (Student letter must
accompany these forms for consideration.)
I understand that I am approving the college to conduct a thorough investigation of my account. The college
willnotifymeinwritingoftheReviewBoard’sdecisionregardingmyappeal.
If I am receiving any nancial aid and this appeal is approved, I understand that it may reduce or
cancel my nancial aid. Any balance or bookstore charges will be due in full and will remain on my account until paid.
 Bookstorechargesarenotrefundablethroughthisappeal
I have reviewed the information contained in this document, and by signing below I understand
the Implications of my appeal
An incomplete application will be returned to you and will not be reviewed.
Student Signature: Date:
Oce of the Registrar
450NorthAvenue•BattleCreek,MI49017-3397
(269)965-4150•fax(269)565.2048
www.kellogg.edu
10/12
OFFICE USE ONLY
Tuition Refund/ Academic Appeal
Refund Appeal Academic Appeal BothAcademicandRefundAppeal
Refund Appeal: Approved Denied Tabled Beyond1yeartimelimit
Academic Appeal Approved Denied Beyond3yeartimelimit
Change of grade from to
FullRefund:AnypaymentduebacktostudentwillbemailedtoaddressonrecordintheRegistrar’sOce
Partial Refund Percentage:
AnypaymentduebacktostudentwillbemailedtoaddressonrecordintheRegistrar’sOce.
Lettertostudentsenton: BusinessOce:
ACADEMIC AND REFUND
APPEAL FORM
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ACADEMIC AND REFUND APPEAL FORM Kellogg Community College (Kellogg Community College)

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Completed 26 July 2020

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