Fillable Form Tuition Refund Request (Blue Ridge Community College)

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Form Tuition Refund Request (Blue Ridge Community College)

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The Form Tuition Refund Request (Blue Ridge Community College) form is 1 page long and contains:

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Blue Ridge Community College
Appeal for Tuition Refund for a Class Dropped After the Published
Last Date for Refund
1. EMPLID __________________________________
2. NAME ____________________________________
3. ADDRESS _______________________________________________________________________
CITY __________________________________ STATE ________________ ZIP CODE _________
4. SEMESTER SUMMER FALL SPRING YEAR ___________
5. List of the courses from which I have withdrawn and for which the grade status is “W”:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________
6. I understand that Virginia Community College System policy allows Blue Ridge Community College
to grant refunds after the published last day for refunds in certain situations (see the attached policy).
Because of the situation described below, I am requesting a refund after the published last day for refunds
(please use the back of this sheet, if necessary). I have attached supporting documentation.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
7. Please place a check in the box by the reason (definitions are below) that pertains to your appeal:
o Major medical emergency
o Extreme financial hardship
o Death of an immediate family member
o Administrative error by BRCC personnel
o Ordered to active duty or mobilized
8. Student Signature _____________________________________________ Date _________________
Definitions
Major medical emergency - An extended illness or major medical emergency occurring during the
semester in which you are registered which requires hospitalization, is life-threatening, or is contagious
and is a danger to the remainder of the college community.
o Documentation will be by a physician’s statement on the doctor’s official letterhead (copies
of the student’s medical records will not be accepted). This must be an unscheduled medical
emergency diagnosed after the last day to drop for tuition refund
o The physician’s letter must include the date the student was first seen for the medical
condition, as well as the beginning and ending date the student was incapacitated or
hospitalized and must state that the student was physically unable to attend classes during this
period of time (which caused the student to miss 20 percent or more of the scheduled
instruction).
o A letter that does not specifically state, “the student was physically unable to attend classes”
will not be grounds to approve an appeal.
o Pre-existing conditions are not justifiable.
Extreme financial hardship – involving the sudden, unforeseen loss of an extreme nature. An example
of such an extreme hardship would be that caused by the loss of the student’s owned home through fire or
flood.
Death of a student’s immediate family member - with certification. A student’s immediate family is
defined as father, mother, spouse, sibling, or your child.
Administrative errors by BRCC personnel. The appeal for refund in these instances must be initiated
through, and with the concurrence of, the BRCC employee providing you the advice and counsel.
A student ordered to active duty (for reservists) or be mobilized (active military) as described in
Code of Virginia, Section § 23.1-904
Return This Form and supporting documentation to:
Vice President of Finance and Administration Armstrong Hall – Room C108
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Vice President of Finance & Administration Action:
( ) Refund Approved ( ) Refund Approval Declined
________________________________________________________________________________
Vice President of Finance & Administration Date
Original - Admissions & Records Office
Copies to:
o Requestor
o VP Finance & Admin.
o Business Office
o Financial Aid
Revised 12/14/17
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Form Tuition Refund Request (Blue Ridge Community College)

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Completed 26 July 2020

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