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Student Name: _________________________________________________ SID number: __________________________
Address: ______________________________________________________________________________________________
City: ____________________________________________________________ State: __________ Zip: ________________
CBC Email (required): __________________________________________________________________________________
Telephone: ____________________________________________________________________________________________
Quarter/Year (eg. 2018): Summer ___________ Fall ___________ Winter ___________ Spring ___________
Have you been granted a Petition for Refund at any other time? If so, when _____ / _____ / _____
Tuition, Fees, and/or Withdrawal
The Petition for Exception to Deadline (PED) is a formal request for an exception to a published
college policy. It can be approved only when the circumstance for the request is due to illness, death
of an immediate family member, military service, or hardship. The PED will only be considered if the
request is accompanied by appropriate documentation to support the circumstance.
It is the student’s responsibility to follow the PED procedure guidelines to:
a. submit the typed PED no later than one quarter following the quarter in question
b. type all statements and information into the PED form
c. communicate clearly in the Personal Statement section of the PED stating the grounds for the petition
d. provide the appropriate documentation as described in the Exception Category of the PED
A response will be issued via your CBC student email address within 15 instructional days. Therefore,
students must have an established CBC student email account before submitting the petition.
The tuition refund policy of Columbia Basin College is established by the Board of Trustees, printed
in the current Quarterly Information and developed from the Washington State RCW 28B.15.605 and
Note that refunds for federal nancial aid recipients are calculated according to federal regulations.
Please consult with the Student Financial Aid Ofce for additional information prior to completing
the PED.
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Below are the types of exceptions the college may consider. Please mark ONE category most
appropriate for your circumstance:
Provide appropriate documentation as described in the Exception Requirements
Medical: Incapacitating injury or illness to yourself or of an immediate family member
(spouse, son, daughter, foster child, grandchild, sister, brother, father, mother,
grandparent, guardian, or ward).
Exception Requirements: A statement from a healthcare provider is appropriate
medical documentation if it is written on a doctor’s letterhead, if it includes
the recuperation timeline, and if it explicitly addresses the ways in which the
illness impacted your ability to perform normal academic tasks. No medical
records will be accepted.
Death: A death of an immediate family member (spouse, son, daughter, foster child,
grandchild, sister, brother, father, mother, grandparent, guardian, or ward).
Exception Requirements: Death in the immediate family must be veried by
an obituary notice, a memorial folder, or any other documentation showing
your relationship to the deceased individual.
Military Services: Orders to report for active duty.
Exception Requirements: A copy of written military orders must be submitted.
Hardship: A signicant and unanticipated personal emergency/circumstance beyond the
control of the petitioner.
Exception Requirements: Documentation specifying the date of the personal
emergency or circumstance with sufcient details to support the PED. Provide
supporting evidence.
By submitting this PED, one of the following may occur: reimbursement of tuition/refundable fees
and/or withdrawal.
Be sure to include specic class information, otherwise it’s assumed all classes are included in your
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All PEDs require a personal statement with sufcient information supporting the selected exception
category. An exception process exists because situations may sometimes occur which cannot be
avoided or predicted. However, when ling an exception, you must remember that you are asking
CBC to make an exception to a college policy. In order for the College to determine whether your
situation qualies for consideration of an exception, you will need to provide sufcient detail and
documentation (as described in the Exception Category of the PED) to support this request. Within
the next few pages, please provide the pertinent information related to your situation. This petition
must be typewritten (type directly into PED form) and is limited to the number of characters you may
type in each section.
The “Introduction” Section
Briey state what you are requesting. For example: “I missed the withdrawal deadline because I was
extremely ill and was hospitalized. I wish to be withdrawn from all of my classes.” (maximum 300
The "Detail” Section
Provide sufcient detail about your situation to justify making an exception. Focus on the pertinent facts
because you are limited in the number of characters allowed. Because you must submit documentation
with this PED (as described in the Exception Category of the PED), please refer in this section to the
documentation you are submitting with the petition. (maximum 866 characters)
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The “Conclusion” Section
Provide any additional information that may be helpful to the evaluator in making a decision as to
whether your PED will be approved or denied. (maximum 300 characters)
By signing this document, I certify the information I am providing on this form and on any supporting
documentation is true and accurate to the best of my knowledge
. I understand that if the documentation
submitted with this PED is incomplete or lacks relevancy, my PED will be denied. All decisions are nal.
Student’s Signature: _____________________________________________ Date: ___________________
Submission of falsied information or misrepresentations of fact are a violation of the CBC Student Code of Conduct (WAC 132S-
100-230) and may be cause for disciplinary action.
This PED can be submitted in person at Hawk Central or by US Postal Service to the following address.
PEDs will not be accepted via email or fax.
Student Records
Columbia Basin College
2600 N. 20th Avenue, MS-H4
Pasco, WA 99301
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and afrmative action. CBC does not discriminate on the basis of race, color, creed, religion,
national or ethnic origin, parental status or families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or military status, or the presence of any sensory, mental, or
physical disability, or the use of a trained dog guide or service animal (allowed by law) by a person with a disability, or any other prohibited basis in its educational programs or employment. Questions or complaints may be referred to the Colleges Title IX/EEO
Coordinator: Camilla Glatt, Vice President for Human Resources & Legal Affairs, 2600 N. 20th Avenue, Pasco, WA 99301, telephone (509) 542-5548, email Individuals with disabilities are encouraged to participate in all college spon-
sored events and programs. If you have a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in alternative media by request.
Rev. 8’19