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Student Name: _____________________________________________ SID number: __________________________
Address: ______________________________________________________________________________________
City: _______________________________________________________ State: __________ Zip: ________________
CBC Email (required): ___________________________________________________________________________
Telephone: ___________________________________________________________________________________
Quarter/Year (eg. 2020): Summer __________ Fall __________ Winter _________ Spring _________
Have you been granted a Petition for Exception to Deadline 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, hardship, or when there is documented
evidence of institutional error. The PED must be is accompanied by appropriate documentation
to support the circumstance.
When you submit a PED, it is your responsibility to:
a. submit the typed PED no later than one quarter following the quarter in question
b. state the grounds for the petition in the Personal Statement section of the PED
c. 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.
Establishing a CBC student email account is required prior to submitting the petition.
The tuition refund policy of Columbia Basin College is established by the Board of Trustees,
printed in the current Catalog and developed from the Washington State RCW 28B.15.605 and
Note that refunds for financial aid recipients are calculated according to federal and state
regulations. Please consult with Hawk Central for additional information prior to completing the
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Below are the types of exceptions the college may consider. Please mark ONE category most
appropriate for your circumstance. Only one exception category will be considered by the
Provide appropriate documentation as described in the Exception Requirements
Medical: A significant and unanticipated incapacitating injury or illness to yourself
or an immediate family member. An immediate family member is defined
as a spouse, child, foster child, grandchild, sibling, parent, grandparent,
guardian, or ward.
Exception Requirements: A statement from a healthcare provider which
must: be written on a doctors letterhead; include the specific timeline
(eg, when treatment began/ended, duration of hospitalization, and/or
recuperation period); and explicitly address the impact on your ability to
perform normal academic tasks. No medical records will be accepted.
Death: A death of an immediate family member. An immediate family member
is defined as a spouse, child, foster child, grandchild, sibling, parent,
grandparent, guardian, or ward.
Exception Requirements: An obituary notice, memorial folder, or any other
documentation showing your relationship to the deceased individual.
Military Service: Orders to report for unanticipated active duty.
Exception Requirements: A copy of written military orders must be
Hardship: A significant and unanticipated personal emergency or circumstance
beyond the control of the petitioner.
Exception Requirements: Documentation specifying the date of the
personal emergency or circumstance with su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.
If specific class information is not included, it will be assumed all classes are included in your
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All PEDs require a personal statement with sucient information supporting the selected
exception category. An exception process exists because situations may sometimes occur
which cannot be avoided or predicted. In order for the College to determine whether your
situation qualifies for consideration of an exception, you will need to provide sucient detail and
documentation (as described in the Exception Category of the PED) to support this request for
CBC to make an exception to a college policy. Within the next few pages, please describe your
situation and how it aected your ability to perform normal academic tasks. This petition must
be typewritten (type directly into PED form) and is limited to the number of characters you may
type in each section.
Briefly state the exception 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 characters)
Provide sucient detail about your situation to justify making an exception. Focus on the
pertinent facts and specific dates of the circumstance within 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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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 final.
Student’s Signature: ________________________________ Date: ___________________
Submission of falsified 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 to Hawk Central or by US Postal Service.
Rev. 5’20
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 Vice President for Human Resources & Legal Affairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548.Individuals with disabilities are encouraged to participate in all college sponsored 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.
In Person:
Hawk Central
H Building
Pasco Campus
US Postal Service:
Student Records
Columbia Basin College
2600 N. 20th Avenue, MS-H4
Pasco, WA 99301
Hawk Central
We are temporarily unable to accept this form 'In Person' while our campuses operate remotely.
Please submit the completed form and documentation via mail
or from your CBC email (as listed above).
click to sign
click to edit
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