Fillable Fair Petition For Waiver Of Financial Regulations (California State University Channel Islands)

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Fair Petition For Waiver Of Financial Regulations (California State University Channel Islands)

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Student Business Services
Sage Hall
One University Drive Petition for Waiver of Financial Regulations
Camarillo, CA 93012
Phone: (805) 437-8810
Read the instructions on this form. Return the completed petition and supporting documentation (in person or by
mail) to the Student Business Services office in Sage Hall. Faxed or scanned documents are not accepted.
I am requesting a waiver of financial regulations for: TERM ___________ YEAR _____________
Waiver of Late Payment Fee Late refund (specify amount ______________)
Billing correction only Other (specify) ____________________________________
*Please provide all the information required below and print clearly. Do not leave any of the fields blank.
Name ________________________________________________
Address _______________________________________ Student ID _______________________
City ____________________ State _______ Zip _______ Phone (home) ____________________
Email _________________________________________ Phone (cell) ______________________
My signature on the line below acknowledges that I have read and fully understand instructions on the reverse
side of this form. I also affirm, to the best of my knowledge, that the statements provided are true.
Student Signature ________________________________ Date ______________________
Use the space below to fully explain your situation and justification for this petition. If additional space is needed you may use an attachment
and provide pertinent supporting documentation to your claim.
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Are you a recipient of Financial Aid? Yes No
FAIR Committee Decision: Approved Denied No Action Required
Comment ___________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Signature ___________________________________________ Date _______________________
FAIR Committee Representative
Student Business Services
Sage Hall
One University Drive Petition for Waiver of Financial Regulations
Camarillo, CA 93012
Phone: (805) 437-8810
LATE PAYMENT OF FEES
You must explain the reasons you were unable to pay your tuition and registration fees by the published deadline.
BILLING CORRECTIONS
You may request a billing correction if you believe that you were billed for tuition and registration fees in error.
You are responsible for payment of all units you are enrolled in, beginning with the first day of classes. You are
responsible for dropping or withdrawing from their class(es) regardless of ever attending. If you are requesting a
billing correction due to medical reasons, you must submit documentation from your physician that clearly
describes at a minimum the nature of your illness or disability and the exact period of time you were unable to
attend classes.
LATE REQUEST FOR REFUND OF FEES & TUITION
Title V of the California Code of Regulations provides for late application of refunds only “in the case of death,
disability, compulsory military service, or if a University rule” prevents you from continuing to attend classes.
Death:
A copy of the death certificate and explanation of the relationship to the deceased must be submitted with
the petition.
Disability:
A letter on business letterhead from your attending physician certifying how your condition or situation
affected your ability to continue enrollment at CSU Channel Islands and must clearly state the period of time
affected.
Compulsory military service:
Reporting documents must be submitted with the petition.
University Rule:
is when you are administratively withdrawn from your classes because you did not meet a
University requirement. This rule does not apply to students who are disenrolled due to non-payment of tuition
and registration fees or insufficient payment of tuition and registration fees. Documentation of the administrative
drop is required.
Refunds are based on the date you drop or withdrew from classes.
If you feel that your late request for a refund is justified based on one or more of the above criteria, complete and
submit the following three documents to Student Business Services: 1) Petition for Waiver of Financial Regulations,
2) Refund Request for Tuition and Registration Fees, and 3) Written documentation to support your request.
Submission of petition with certified documents does not guarantee committee approval.
You will be notified by email of action taken on your petition. If your late refund request is approved, a check will
be mailed to the address on file unless specified otherwise. Any outstanding obligations to the University will be
deducted from your refund.
Questions may be directed to the F.A.I.R. Committee coordinator at (805) 437-3536 or by
emailing student.accounting@csuci.edu
.
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Fair Petition For Waiver Of Financial Regulations (California State University Channel Islands)

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Completed 19 July 2020

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