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Petition For Exception To Tuition Refund Form Fillable

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Petition for Exception to Tuition Refund Policy for
Dropping Courses
Note: Students must withdraw from course(s) before petition will be considered.
Name: Last First Middle myWSU ID#
Address: Street Address or P.O.# City State Zip Code
Telephone: Email Communications will be sent to your official WSU email address.
CRN #
Classes for which I am petitioning
for a refund: Dept./Catalog #
Credit
Hours
% Refund
Requested Semester/Date Class Began
Last Day
Attended
I hereby petition the Tuition Refund Board of Appeals for an exception to the WSU
policy on tuition refunds. I have stated my reason(s) below and provided the appropriate
documentation.*
*Pr
ovide appropriate documentation from someone other than yourself to support the
above request (examples of appropriate documentation: statements from physician,
employer, advisor, or other person(s) who can verify your situation). The Board may be
unable to consider your petition without documentation. Documentation materials will
b
e kept in confidence and distributed only to University personnel with a need to know.
I have read the WSU Policies and Procedures and affirm that my statements and documentation are a true accounting of my situation.
Stud
ent’s signature Date
For office use only
Director’s Action:
Gross Amount of Tuition
Eligible For % Refund
Approved For % Refund
Referred to Appeals Board
Reason Code
Date Initials
Bo
ard Action:
Approved for % Refund
Denied
Reason Code
Date Initials
University Refund Policy — Complete and Partial Withdrawals
A student who believes his/her situation requires an exception to the refund policy must submit a Petition for Exception to Tuition
Refund Policy for Dropping Courses for consideration by the Tuition Refund Board of Appeals.
Stude
nts are eligible for refunds as defined in the Comprehensive Fee Schedule.
To
be considered for a tuition refund, students must drop their class(es) in one of two ways based on whether the deadline has passed:
1. Prio
r to the last day to withdraw, the student can drop their courses in the myWSU portal.
2. After the deadline to withdraw, the student will need to contact their academic advisor.
Note: If a hold exists, this may pr ohibit the student’s ability to dr op cour se(s) and the student will need to resolve the hold or
contact Accounts Receivable.
Stude
nts receiving federal financial aid will be subject to the refund regulations established by the federal government. Contact the
Office of Financial Aid for details.
This
petition is for tuition, student fees and course related fees. Mandatory fees, late fees and the $130.00 down-payment of the
payment plan are not refundable.
Procedure to Petition an Exception to the above Policy
1. Return this completed form with attached documentation to Accounts Receivable via email, fax or in person.
2. The petition will not be considered if appropriate documentation is not provided (see * on page one).
3. The Director of Student and Accounts Receivable will decide as soon as possible or refer to a designee.
4. If the Director denies the petition, it will be forwarded to the Tuition Refund Board of Appeals. A decision will ordinarily be
made within ten business days from the time the request was received. The Board’s decision is final. The Board will reconsider
appeals only if new information is provided within 30 days.
5. Notifications will be sent by email.
Not
having proper documentation and/or not withdrawing from classes could result in delaying the petition process.
Questions:
Accounts Receivable Office
Room 201 Jardine Hall
Phone: 316-978
-3333
Fax: 316-978-3107
E-mail: wsuaccountsreceivable@wichita.edu
Visit us at www.wichita.edu/acctsrec
Revised 08/2019
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Completed 10 March 2020

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