Fill - Free fillable Drop/Refund Policy Appeal Form (Danville Area Community College) PDF form

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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