Select the condition(s) that apply to this request:
Student illness of severity or duration that precludes course completion (Supply confirmation on letterhead from physician
(M.D.) OR an ARC Medical Form.
Death of student or in the immediate family (parent, spouse, child, sibling or grandparent) confirmed by documentation
indicating the student’s relationship to the deceased. (Obituaries, birth and death certificates, etc.)
Active military duty or return from active duty confirmed by military orders.
USF System error confirmed in writing by an appropriate USF System official or by appropriate official USF System
documents. NOTE: The University has a mandatory first day attendance policy and faculty may drop students from a course.
A faculty member’s failure to drop a student IS NOT considered University error and does not justify a refund; It is the
student’s sole responsibility to ensure drops before deadline to avoid fee liability.
Other documented exceptional circumstances beyond the control of the student accompanied by letter of explanation and
appropriate documentation.
Sign and submit this form with written explanation and supporting documentation to the Office of the Registrar on your campus.
If you received financial aid during the term, you acknowledge that any refund generated from this request may be used to repay
the aid programs (including reducing student loan debt).
CRN
Example: 82189
Prefix
ENC
Number
1101
Section
081
Hours
3
In keeping with Regulation USF 4.0101: Student Registration, you may apply for
consideration of a 100% refund of tuition and fees within six (6) months of the end of
a term when you have: Withdrawn or dropped a course AND the Office of the
Registrar has documentation to approve one of the State defined conditions below.
(NOTE: This is a separate process from the ARC petition)
FOR OFFICE USE ONLY
Committee Decision? Approved Denied
Credit hours approved through this fee adjustment ________
Documentation on file with approved ARC form? Yes No
Recipient’s Initials ____________ Hand Delivered Emailed US Postal Service
Identify course(s) for which you are requesting a fee adjustment:
Student Signature ___________________________________________________________ Date ____________________________
PLEASE NOTE: This process can take up to 30 days from the date of submission for the committee’s decision and processing of
the paperwork to be completed. You will be notified of the decision via USF email.
Name __________________________________________________________ USFID Number _________________________________
Address ___________________________________________________________ Phone _____________________________________
City/State/ZIP ____________________________________
Summer Fall Spring
Term
Year ____________
Is this a follow-up to a denial request?
Yes
No
Fee Adjustment Request
Tampa Campus
4202 E. Fowler Ave., SVC 1034
Tampa, FL 33620
St. Petersburg Campus
140 7th Avenue S., BAY 102
St. Petersburg, FL 33701
Sarasota-Manatee Campus
6350 N. Tamiami Trail, SMC C107
Sarasota, FL 34243
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