E
XTENUATINGCIRCUMSTANCEAPPEALFORTUITIONCREDIT
TheColoradoCommunityCollegeSystemallowsastudenttoreceiveatuitionrefundonlywhencoursesaredroppedby
thecensusdate.Intrulyseverecircumstances,ACCwillconsideratuitioncredit.Non‐attendanceorfailingtodropby
thedeadlinedoesnotreleaseastudentfromfinancialresponsibilityandisnotanextenuatingcircumstance.
Lastdateofattendanceinyourcoursesmaybeconsideredaspartofyourappeal.Attendancebeyondthe9th
weekofthesemesterorcompletionof60%ofthecoursemaylimityourabilitytohavethisappealapproved.
InstructionalissuesaretypicallynotgroundsforanappealandneedtobeprocessedthroughtheStudent
GrievanceProcedure:pleaseseetheDeanofStudentsOfficelocatedintheStudentEngagementCenter,Room
M2720,formoreinformation.
Awithdrawalfromacoursewillimpactyourcompletionrate,whichmayhaveanegativeimpactonyour
financialaidstatus.Ifyouhavequestionspriortowithdrawingfromyourcourses,pleasecontactFinancialAid
at 303.797.5661.IfyouhaveVeteranbenefits,contacttheVeteransCertifyingOfficial.
Generally,onlyoneappealwillbeconsideredduringyourattendanceatACC.
Appealsmustbefilednolaterthanonesemesterafterthesemesterinquestion:Summersemesterdeadlineis
December1,FallsemesterdeadlineisMay1,andSpringsemesterdeadlineisAugust1.
REQUIREDDOCUMENTATION:
Completedformandstatement
MedicalDocumentationform(ifapplicableandmedicalrelated)
Supportingdocumentation(seebelowforexamplesofacceptabledocumentation)
Adequatedocumentationmustbeincludedtosupportyourstatem
ent.Examplesofacceptablecircumstancesand
documentationincludebutarenotlimitedto:
Death:Forthedeathofafamilymember,submitadatedobituaryornewspaperclipping,funeralnoticeor
deathcertificate.Iftherelationshipisnotclearfromthedocumentation,pleaseexplain.
SeriousMedicalCondition:TheMedicalVerificationformshouldbecompletedbyamedicalprofessional.A
signedl
etteronofficialletterheadfromyourmedicalprofessionalisacceptable.Billingstatementsarenot
acceptedasrequireddocumentation.StudentsmayrequestaprivatemeetingwithStudentAffairstohavethe
ir
medi
caldocumentationreviewedandverifiedpriortosubmittinganappeal.
NaturalDisaster:Documentedflood,fire,etc.DocumentationmayincludeaninsuranceorFEMAclaim.
STUDENTINFORMATION:
SID:__________________________________Name:__________________________________________________
StudentE‐mailaddress:___________________________@student.cccs.eduDateofBirth:________________
Phone:______________________________
COURSEINFORMATION:AppealSemester/Year:___________________
CourseID CourseTitle Credits WithdrawalDate
CourseID CourseTitle Credits WithdrawalDate
CourseID CourseTitle Credits WithdrawalDate
CourseID CourseTitle Credits WithdrawalDate
STUDENTINSTRUCTIONS:Reviewthisappealform,withdrawfromyourcourses,completetheform,attachthe
necessarydocumentation,andsubmitittoacc.dos@arapahoe.eduorinpersonatM2720.
Revised: 10.03.19 JH
Didyouhavefinancialaidduringtheperiodinwhichyouareappealing?
No
IfyourappealisapprovedandtheresultingcreditexceedstheamountowedtoACC,pleasedirectACCon howto
proceedwiththecreditbycheckingtheboxofONEoftheoptionsbelow:
Keep the whole credit on your student account to be applied towards the next term’s tuition and fees.
Have the loan portion sent back to your lender to reduce your overall student loan debt. If there is still a
remaining credit, keep that credit on your student account to be applied towards the next term’s tuition
and fees.
Have the loan portion sent back to your lender to reduce your overall student loan debt. If there is still a
remaining credit, have that credit sent back to you.
Send the whole credit back to you.
Explainthecircumstancethatpreventedyoufromattendingyourclass(es)andthereasonyoudidnotdropyour
course(s)withintheapproveddropperiod.Provideacompletestatementandincludeatimelineofevents.Ifyouare
notappealingallofyourenrolledcoursesforthesemester,pleaseincludeinyourstatementhowyoursituationonly
impactedsomeandnotallofyourcourses.Attachatypedstatement,ifadditionalspaceisneeded.
SubmitappealstotheDeanofStudentsOfficelocatedintheStudentEngagementCenter,RoomM2720,oremailto
acc.dos@arapahoe.edu.ConfirmationwillbesenttoyourACCstudentemailaccountuponreceiptofyourappeal.
AppealdecisionsarefinalandwillbecommunicatedtoyouthroughyourACCstudentemailaccountapproximately4‐6
weeksafterreceiptofyourappeal.Itisyourresponsibilitytofollowuponthestatusofyourappeal.
Tuitioncreditforapprovedappealswillbeappliedtoafuturesemesterortoreduceyourexistingloanbalance.This
appealmaynotimpactthestatusofyourcurrenttuitionbill,ifapplicable.
YourstudentemailwillbeusedbyACCtocommunicatewithyouaboutyourappeal,includingrequestsforadditional
documentation.
Bysigningthisappeal,Icertifythatallinformationprovidedisatrueandaccuraterepresentationofmysituation.
Further,Ihavereadthisformandunderstanditscontentsandagreetotheterms.Iacknowledgeitismyresponsibility
tofullyunderstandhowthisappealwillimpactmyacademicrecordandfinancialstanding.
__________________________________________________________________________________ ________________________________
StudentSignature Date
Revised: 10.03.19 JH
Please select all applicable categories:
I am using GI Bill/Veteran Benefits to pay for classes.
I am a high school student, concurrently enrolled.
A third-party payer pays for my classes.
Yes
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