Refund Chair Signature:
5/31/16 1 RO Correspondence Incoming
P.O. Box 97 Valdez, AK 99686 Phone
(907) 834-1632 Fax (907) 834-1635
Petition for Refund
Type of Request (check one or both): Course Refund/Reversal of Charges Late Fees
Name: UA Student ID:
Address: City/State/Zip:
Email: Phone:
Notification will be made to the email above only if it is in your student profile. Otherwise, it will be sent to your student email account. Please contact
Information Technology Services at 907-786-4646 if you need assistance accessing your UA Student ID number, UAOnline account or your student email.
Semester/Year of Refund Request: /
Course(s) you are requesting a refund/ for:
Attach a detailed explanation of what extenuating circumstances prevented you dropping from course(s) by
published registration deadlines. Documentation is required, see page two for additional instructions.
A petition for refund will only be considered if a student can demonstrate unanticipated and unavoidable
events beyond a student’s control that justify a refund. Work-related issues, financial hardship, and failure to
read PWSC’s documents generally do not present justifiable reasons to support a petition request.
By signing below I 1) certify that the information contained in or included with this request is true and
accurate, and 2) authorize anyone contacted by PWSC in connection with this request to discuss my petition
and to release relevant documentation in their possession to PWSC.
Student Signature: Date:
Committee Use Only
Refund: Approved Denied Amount WX WP RX
Date:
For office use only
In general, this form can be used to request a refund (or reversal) of tuition and/or late fees. Please read all
instructions on page two of this form before submitting this petition. Incomplete petitions may not be
considered. Please allow a minimum of 3-4 weeks for a request to be reviewed and notification to be made.
In general, this form can be used to request a refund (or reversal) of tuition and/or late fees. Please read all
instructions on page two of this form before submitting this petition. Incomplete petitions may not be
considered. Please allow a minimum of 3-4 weeks for a request to be reviewed and notification to be made.
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5/31/16 2 RO Correspondence Incoming
Petition for Refund: Instructions and Overview
Petitions are to be submitted to:
OR
Physical Address
303 Lowe Street
Valdez, AK
Mailing Address
Prince William Sound College
Registrar's Office
P.O. Box 97
Valdez, AK 99686
The information below is intended to provide a description of the process and reasons that may support a
request. Exceptions are not
automatic and will be granted on case-by-case basis in light of
circumstances and documentation. Students are required to provide
supporting
documentation with this request to substantiate the reasons for being unable to meet published
deadlines or adhere to
current policies. Requests without documentation may be returned and not
considered.
1. Only requests submitted by the student or by a person with legal authority to act on behalf of the student will be considered.
2. The deadline to submit a Request for Refund is no later than one academic year following the semester in which the course was
offered. (Note: Requests that are not received within this timeframe will not be considered.)
3. Requests to drop or withdraw from course(s) must be applied for separately using the Request for Late Add or Retroactive
Withdrawal form found at http://pwsc.alaska.edu/forms/.
4. Decisions will be made solely on supporting documentation provided. In all cases a personal statement from the student is
required summarizing the situation and explaining the need for a refund.
* Immediate family is defined as father, mother, brother, sister, husband, wife, domestic partner, son or daughter.
5. A request will only be approved if the requester can demonstrate unanticipated and unavoidable circumstances beyond the
student’s control that arose or came to light after published deadlines. Work-related issues, financial hardship, and failure to
read PWSC’s documents generally do not present justifiable reasons to support an exception request.
6. Appeals of an adverse decision must be in writing, provide additional documentation not presented in original request and be
received within
10 working days of the day the decision is mailed or otherwise distributed to the student. Appeals of
decisions are at the discretion of the Campus Director and should be routed as described in the notification letter.
Campus Director
Dr. J. Dan O'Connor
P.O. Box 97
Valdez, AK 99686
Reason for Request
Minimum Supporting Documentation Required
Advising error
Academic advisor’s written confirmation and explanation of advising error.
Crisis situation
Letter on letterhead from legal, medical, or other relevant professional. Police
report, court order, visa, airline ticket, or other relevant documents.
Death of immediate family member*
Dated copy of death certificate published obituary, or memorial folder. (If
student’s last name differs, documentation required that establishes immediate
family relationship to the deceased).
Financial difficulties
Documentation of a university error directly causing the financial problem.
Please note: Financial exceptions are rarely approved, unless there are special
circumstances; students are responsible for managing their personal finances.
Instructional difficulties
Supporting information and recommendation by department chair or dean
Job conflict
Employer’s letter on letterhead confirming date and necessity of job changes.
Please note: Voluntary work schedule changes or commitments made by the
student are rarely approved unless exceptional circumstances can be
documented. Students are responsible for management of personal scheduling
that may impact their educational commitments.
Medical condition
(student or immediate family member* only)
Doctor’s letter on letterhead verifying nature of condition and dates of treatment.
Military duty
Copy of official order to report for training or active duty.
Other reason
Written documentation from relevant officials or entities on company letterhead
or similar.
Registration problems
Relevant supporting documentation, e.g. email or other correspondence with
university personnel about registration intentions or difficulties.