Registrar's Office
501 Crescent Street
New Haven, CT 06515-1355
Phone: 203-392-5301
Fax: 203-392-7144
Email: Registrar@SouthernCT.edu
Web: OneStop.SouthernCT.edu
Date:
60% 40% 0%
No Change
Revised Withdrawal Date: _________________________
Refund of Tuition and Fees: 100% 90%
*Housing charges will be prorated based on expenses already incurred for 100% approved refunds, and otherwise, will follow the approved refund amount above.
Regardless of any refund approved, meal plans will be prorated based on expenses already incurred.
Dean of Students: ______________________________________________ Date: ____________________
President/Designee: _____________________________________________ Date: ____________________
Revised 3/23/2020
No Change
Appeal of University Withdrawal or Leave of Absence
Students may file this appeal with the Registrar's Office to request a review of their Leave of Absence or University
Withdrawal, within 30 days following the end of the semester under appeal. The decision issued by the committee is final,
and there is no further campus review or appeal. Appeals will generally be reviewed within 3-4 weeks, and a response will be sent
to the students University email or the mailing address on file.
The appeal process exists to assist students who can present information regarding unforeseen personal circumstances beyond
their control that may have impacted their ability to remain in attendance at the University. The committee will thoroughly
review individual files, time-lines, and the governing state/federal policies to determine the withdrawal date that most
accurately reflects when a student ceased academic attendance due to extenuating circumstances. The appeal process also
exists for students serving in the United States Armed Forces, including the National Guard or Reserve, who have been called or
ordered to active duty for a period of more than 30 consecutive days.
Submitting this request does not change any current academic or financial responsibilities. Any reduction to charges authorized
by the University President, or designee, will be calculated after any grant or scholarship aid that has been applied to your tuition
and fees. Financial Aid recipients should contact the Office of Financial Aid & Scholarships, as a change to your withdrawal may
also reduce financial aid awards, which could result in the student owing funds to the University and/or government.
Student ID:
Name:
Address:
Phone:
Email:
Semester/Year:
Directions:
Complete and submit this application. Include a narrative statement that states the relevant University policy, the extenuating
circumstances that prevented you from adhering to the policy, and the resolution or exception sought. Students are encouraged
to submit supporting documentation to substantiate their circumstances.
Student Signature:
Note: Students may create a digital ID using their SCSU email by clicking the signature block above, or the form may be accepted as an
attachment from their SCSU email without a signature.
Institutional Decision - (Office Use Only)
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