TUITION APPEAL
NAME OF STUDENT INITIATING THE APPEAL: ________________________________________
ADDRESS: ____________________________________________________________________
PHONE NUMBER: ____________________________
STUDENT ID #: _____________________ DATE: ____________
I _________________________________________, wish to appeal my tuition for the
following course(s): _______________________________or all courses for the
___________________semester.
The student must officially withdraw from course(s) being appealed prior to submitting the
Tuition Appeal Procedure Form. If appeal is based on a medical problem
, please have your attending
doctor submit documentation to substantiate your claim along with the Tuition appeal Procedure Form.
If appeal is based on work schedule
, please submit documentation from employer to substantiate your
claim along with the Tuition appeal Procedure Form. (An additional form will be provided regarding
required documentation for medical and work schedule appeals).
Please state in space below the reason for your tuition appeal:
(If more space is required, please attach additional sheets)
Student Signature__________________________________
Please return form to: Clinton Community College
Attn: Bursar’s Office
136 Clinton Point Drive
Plattsburgh, NY 12901
Rev. 9/30/13
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