Extenuating Circumstances Refund Request Form Rev June 2020
Extenuating Circumstances Refund Request Form
Students who find it necessary to drop individual classes or withdraw from school may apply for a refund if class(es) are dropped
within 10 percent of the scheduled class time. They should submit a “Refund Request Form”. Critical dates for each course (i.e.; Last
day to drop with a refund, Last day to drop without a “W”, etc.) are listed on myHancock class schedule. The deadlines for your class(es)
are listed on myHancock under “Schedule/Fees/Deadlines.
A student may submit this form if he/she was not able to drop classes by the published deadline due to extenuating circumstances.
This may include family emergencies, injury, illnesses or employment. All situations require written verification from an official source
and must have documented dates confirming the extenuating circumstances.
Name: H# Semester/Year
(Last) (First) (MI) Student I.D. Number
Address: Tel#
(Street) (City) (State) (Zip Code)
Information needed for refund exception (student must complete each of these sections):
Course Name
Last day to drop
with refund
Date class was dropped
All three items listed below must be attached to this form:
Written statement explaining reason for refund exception request
Supporting documentation (Signed medical/doctors notice, Signed letter from employer, etc.)
Copy of your unofficial transcript
Student Signature: Date:
(Required for processing)
Submit completed form and attachments to:
Email to: (to protect your privacy, email from your
Hancock College email address)
Holly Costello, Coordinator, Student Services
at hcostello@hancockcollege.edu
Or mail to:
Allan Hancock College
Vice President, Student Services Bldg. A213
800 South College Drive
Santa Maria CA 93454-6399
For refund questions, contact Catalina Staugaard at cstaugaard@hancockcollege.edu. For general inquiries, contact Holly Costello at
Recommendation: Approved Denied
Nohemy Ornelas, Associate Superintendent/Vice President, Student Services
Final Decision: Approved Denied
Eric D. Smith, Associate Superintendent/Vice President, Finance and Administration
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