Fillable E STUDENTINSTRUCTIONS:Reviewthisappealform,withdrawfromyourcourses,completetheform,attachthe necessarydocumentation,andsubmitittoacc.dos@arapahoe.eduorinpersonatM2720. XTENUATINGCIRCUMSTANCEAPPEALFORT

Fill Online, Printable, Fillable, Blank E STUDENTINSTRUCTIONS:Reviewthisappealform,withdrawfromyourcourses,completetheform,attachthe necessarydocumentation,andsubmitittoacc.dos@arapahoe.eduorinpersonatM2720. XTENUATINGCIRCUMSTANCEAPPEALFORT Form

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E STUDENTINSTRUCTIONS:Reviewthisappealform,withdrawfromyourcourses,completetheform,attachthe necessarydocumentation,andsubmitittoacc.dos@arapahoe.eduorinpersonatM2720. XTENUATINGCIRCUMSTANCEAPPEALFORTUITIONCREDIT TheColoradoCommunityCollegeSystemallowsastudenttoreceiveatuitionrefundonlywhencoursesaredroppedby thecensusdate.Intrulyseverecircumstances,ACCwillconsideratuitioncredit.Nonattendanceorfailingtodropby thedeadlinedoesnotreleaseastudentfromfinancialresponsibilityandisnotanextenuatingcircumstance. Lastdateofattendanceinyourcoursesmaybeconsideredaspartofyourappeal.Attendancebeyondthe9th (Arapahoe Community College)

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The E STUDENTINSTRUCTIONS:Reviewthisappealform,withdrawfromyourcourses,completetheform,attachthe necessarydocumentation,andsubmitittoacc.dos@arapahoe.eduorinpersonatM2720. XTENUATINGCIRCUMSTANCEAPPEALFORT form is 2 pages long and contains:

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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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E STUDENTINSTRUCTIONS:Reviewthisappealform,withdrawfromyourcourses,completetheform,attachthe necessarydocumentation,andsubmitittoacc.dos@arapahoe.eduorinpersonatM2720. XTENUATINGCIRCUMSTANCEAPPEALFORTUITIONCREDIT TheColoradoCommunityCollegeSystemallowsast

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Completed 25 July 2020

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