Exception Request Form
See back of form for Instructions
Name: ______________________________________ E-mail address: _______________________________________
Banner ID: __________________________________ Fall 20 _______ Spring 20 _______ Summer _____
Phone: ______________________________________ Last date you attended classes: ___________________________
Have you spoken with an Academic Counselor? Yes No Name: ____________________________________________
Are you receiving Veteran (VA) Benefits? Yes No If yes, VA Counselor must initial here: __________________
Are you an F-1 Visa International Student? Yes No If yes, Academic Counselor must initial here: _____________
Applied or Awarded Financial Aid at HonCC? Yes No If yes, Financial Aid Office must initial here: _____________
Check all that apply:
Tuition Refund Late Withdrawal Late Admission Application Other ____________________________
Course Alpha/Number
Reason(s): Please indicate the extenuating circumstance(s) by which you are petitioning for a policy/procedural exception.
Check all that apply. You are required to submit documentation to support your claim(s) of extenuating
Death of immediate family member (copy of obituary or death certificate)
Serious illness or injury (physician’s note)
Involuntary job transfer (official notice on company letterhead)
Military service (military orders)
Recalled in support of national emergency (official notice)
Birth or adoption of child (birth certificate or official documentation of adoption)
Other: _____________________________________________________________________________________
I certify that the information provided above is true to the best of my knowledge. I understand that providing incorrect or false information may
subject me to the requirements and/or disciplinary measures as provided under the University’s Student Conduct Code. I understand that I may be
required to provide additional certified or official documentation to support my claim(s) of extenuating circumstances. I understand and agree that
registration changes may affect my future eligibility for financial aid and may result in a financial obligation. I understand that a decision may take
up to 15 business days.
________________________________________________________________ ________________________________________
Student’s Signature Date
Approved Disapproved
E-mailed Student: __________ Date: __________ Confirmed with FA: Date _____________________
__________________________________________________________ ____________________________________
Registrar’s Signature Date
The Family Educational Rights and Privacy Act of 1974 forbids you to disclose any information about the student, which is contained in this
document, to any other party either outside your organization or outside of the purpose for this disclosure without first obtaining the written consent
of the student.
Rev. 03/02/18
Reset Form
Directions for Submission of
Request for Exceptions to Policy/Procedures/Deadlines
Students have the option and/or right to request for recourse, and/or exceptions regarding
actions taken in the process of the academic journey, including petitioning to appeal policies,
includes posted deadlines due to unforeseen and personal extenuating circumstances.
The student holds the responsibility to prove and provide supporting documentation (to support
the individual’s claim) to HonCC that he/she had an extenuating and/or unforeseen
circumstance(s) for which the student’s exception to the policy or policies should be accepted
by the college.
Students will:
(1) Complete the Exception request form. The Exception request form should clearly
state the individual’s unforeseen and/or extenuating circumstance(s).
Further, the information should clearly state why the individual could not comply with
the policy or policies in addition to any and all deadlines that have passed. For instance,
in the case of petitioning to accept a late application, the student should be able to clearly
state how and or why he/she was not able to submit an application during the time in
which the college was receiving the applications.
(2) Any and all information to support the individual claims should be attached to the
Exception Request Form at the point he/she submits the form for review. Supporting
documentation should be detailed and inclusive, clearly stated, and/or supporting the
individual’s claim. The information will be used to render the decision regarding the
individual’s request.
(3) Upon securing all supporting documents pertinent to the request, submit the Exception
Request Form and attach all supporting documents to the Registrar’s Office.
(4) Should there be questions regarding the request, an official from Honolulu Community
College will call and/or schedule a meeting with the individual to secure the necessary
(5) Upon receiving all information and clarifications as necessary, the individual will be
informed of the decision by way of email.
(6) Exception request decisions may take up to 15 business days.