Fillable Ads79 Petition for Tuition Refund

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Ads79 Petition for Tuition Refund

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ADS 79 1/15
Petition for Tuition Refund
Auburn Hills Campus Highland Lakes Campus Orchard Ridge Campus Royal Oak Campus Southeld Campus
2900 Featherstone Rd. 7350 Cooley Lake Rd. 27055 Orchard Lake Rd. 739 S. Washington 22322 Rutland Dr.
Auburn Hills, MI 48326-2845 Waterford, MI 48327-4187 Farmington Hills, MI 48334-4579 Royal Oak, MI 48067-3898 Southeld, MI 48075-4793
Name ID#
Address
Street City ZIP
Telephone ( ) Telephone ( )
Day Evening Call Day Evening Call
NOTE:
• You must ofcially drop from all sections that you are appealing.
• Financial Aid Recipients: Dropping courses could affect both your current nancial aid award and your eligibility for future nancial assistance.
It is recommended that you contact the Financial Aid Ofce before dropping to understand the consequences of this action.
• If you have a medical or work-related reason for dropping, please contact the Enrollment Services Department for college guidelines before
submitting this form.
I understand that dissatisfaction with a particular teaching style, lack of knowledge of refund deadlines, and disagreement with refund policies
are not grounds for refunds. I understand that I must drop from the course(s) in question before a refund can be considered. I also understand
that submission of this form does not guarantee a refund. I understand that registration and technology fees are non-refundable.
COURSE CODES SECTION NUMBERS SEMESTER YEAR
Course Section Fall
Course Section Winter
Course Section Summer I
Course Section Summer II
Please give a detailed explanation of your request (which should be chronological and give specic dates) on the reverse side, and attach any
documentation that may support your claim.
REFUND TYPE: 50% Refund Invoice Cancellation Removal of no show grade
Hand deliver or mail to the Enrollment Services Department at any of the campuses listed above.
Student Signature Date
Note: You will receive a written notication of approval or denial. If approved, refund checks will be mailed within 4-6 weeks of the notication date.
DO NOT WRITE IN THIS SPACE - FOR OFFICE USE ONLY
Request approved. Process for: 50% of tuition and course fees only Invoice Cancellation Other
Denied Additional Information Required Notication Sent
Dean of Campus Affairs Signature Date
Please give us an explanation of why you feel you are entitled to a refund.
(Please write legibly; use extra sheets if needed)
Student Signature Date
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Ads79 Petition for Tuition Refund

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Completed 27 November 2019

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