Bucks County Community College
Student Appeal for Tuition
To be Refunded
College policy states that no refunds will be made after the drop period. However, the college realizes that there are
extenuating circumstances that can prevent a student from dropping classes by the refund deadline. The deadline for
submitting appeals to the OFFICE OF ADMISSIONS, RECORDS AND REGISTRATION, is the
LAST DAY OF THE
SEMESTER that the student is appealing. Supporting documentation must be submitted with the appeal.
FAILURE TO DO SO WILL RESULT IN DELAY OR FORCE A DENIAL OF YOUR APPEAL.
Attach all documentation to support your request to this form:
• For medical issues, include a letter from a physician or other medical practitioner, on letterhead, detailing the
dates of treatment and statement attesting to student’s condition as reason for withdrawal.
• For a death in your immediate family (parent, sibling, spouse, grandparent, or child), please include a copy
of the death certificate or obituary.
• For change in employment, submit a letter from your employer, on letterhead, stating date of change and
revised hours.
• For any other situations, supporting documentation should likewise be attached.
• For all appeals, include a personal statement of the situation. Be as specific as possible to dates and
circumstances in explaining your request.
Students can initiate an appeal by completing this form and submitting it to the OFFICE OF ENROLLMENT, which is
located in the first floor of the Linksz Pavilion, 275 Swamp Road, Newtown, PA 18940 or fax to 215-968-8110. The
Tuition Appeals Committee will meet to consider each appeal. Students will receive written
notification of the
decision made by the Appeals Committee.
Semester Appealing: Fall 20___ Spring 20___ Summer 20___ Winter Session 20___
Course or Courses Appealing: ____________________ ____________________
____________________ ____________________
____________________ ____________________
Please print: _______________________________________________________
Last Name First Middle
_______________________________________________________
Address
_______________________________________________________
City State Zip
_______________________________________________________
Telephone number Student number
Are you receiving FINANCIAL AID? YES NO
If yes, you should be aware if financial aid has been paid to your account, you may owe funds to the College or
may have to repay any financial aid you received.
Are you receiving VETERANS BENEFITS? YES NO
Please fill out form and do one of the following things:
1. Print, sign, and either mail or fax to us at 215-
968-8110
2. After completing the form, save to your computer
and email to Carol.Ladd@bucks.edu
using your
Bucks email account. (Submissions from personal
email accounts will not be accepted.)
