Drop/Refund Policy Appeal Form
Important Information: The Drop/Refund Policy Appeal is intended to extend the refund
policy for a limited 5-day period for students experiencing extraordinary circumstances. After
the 5-day extension, there are no refunds, and appeals will not be considered. All appeals must
be submitted in writing and include student ID number, current contact information, and
supporting documentation when applicable. The Registrar will review appeals and make a
decision regarding a refund within 24 hours after receiving the appeal form. The Registrar will
then contact the student regarding the decision. If the Registrar cannot contact the student
within 24 hours after an appeal decision has been made, the appeal will automatically be
denied.
Please Print Clearly
Name: _________________________________________ Date: _________________________
Mailing Address: _________________________________ Ph. Number: ___________________
_______________________________________________ Student ID: ____________________
_______________________________________________ Semester: _____________________
Course(s) Student Would Like to Drop:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Reason(s) for Dropping Courses:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Are you receiving financial aid (grants, loans, work study, etc.)?_____ Yes _____ No
Note: If a student is receiving financial aid, he or she must speak with a financial aid
representative and have that person sign below before submitting this appeal form.
Financial Aid Rep. Signature: ______________________________Date:_________________
Student Signature: ________________________________ Date: _________________________
______________________________________________________________________________
For Office Use Only
Decision: ___________________ Registrar Signature: __________________________ Date: _______________
Response from Registrar:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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