ENROLLMENT SERVICES
POLICY EXCEPTION REQUEST
INSTRUCTIONS
Students may request exception to an Enrollment Services policy (i.e.: Refund, late withdraw, deadlines, etc.) due to emergency extenuating
circumstances. Request must be submitted within one calendar year from the end of the quarter in question. All requests must be in writing
and accompanied by official supporting documentation (see details below).
Emergency extenuating circumstances include bereavement, hospitalization, active military duty, incarceration, domestic displacement,
or other emergency extenuating circumstance which directly affects the student’s ability to continue academic studies for the quarter
in question. Examples of non-emergencies include personal work schedule, grade earned will lower overall GPA, never went to class due
to non-emergency, etc.
This form cannot be used for academic policy requests, you can contact the instructor or instructional division for those requests.
Official Supporting Documentation
o Letterhead documentation of Military orders, police incarceration report, death certificate, medical center/attending physician report, etc..
o Bereavement - -- Passing of a student’s family member. Requests based on bereavement must be accompanied by a standard
industry letter from the funeral director, which indicates relationship of the deceased.
o Student Death - -- In the event of a students’ death, the students’ estate may request for current quarter refund. Request must
be accompanied by standard industry letter from the funeral director or a copy of the death certificate, which indicates relationship
of the deceased.
o Medical conditions - -- Medical conditions which prevent a student from continued studies at Green River College must show documented
diagnosis/treatment, follow-up and prognosis as to non-continuance of educational studies. One visit to a doctors’ appointment does
not constitute an emergency extenuating circumstance. Students are urged to contact Disabilities Support Services for qualification of
accommodations that may be extended to the student.
Procedure
1. Combine all required documentation:
❑ Policy Exception Request form (this page)
❑ Written statement of the emergency extenuating circumstance involved and rationale
❑ Official supporting documentation - -- Requests received with only a write-up by the student, family member or friend, without official
supporting documentation, are considered hearsay evidence and cannot be processed. See details above.
2. Submit all required documentation together.
❑ Requests due to medical should be submitted to Disability Support Services (DSS).
❑ All other requests should be submitted to Enrollment Services.
3. Allow 10 business days for researching and processing of request. A response will be sent to your Green River student email address.
STUDENT INFORMATION
Name: Date:
Student ID: Phone:
Address:
Street City State Zip
Exception to Enrollment Services Policy for: ❑ Summer ❑ Fall ❑ Spring ❑ Winter Year:
ES1508PolicyExceptionRqst
1 of 1
OFFICE
USE
ONL
Y
❑ CI/Tr ❑ CO ❑ @ ❑ DB
It is illegal under Federal and State Laws for institutions to change entries on students’ transcripts
(Academic Fraud/Transcript Tampering) without documented emergency extenuating circumstances.
Title 34 - -- Education. Part 33. Sec. 33.3 [Educational Records] Any person who makes a claim that the person knows is false,
fictitious, or fraudulent is subject to a civil penalty of not more than $5,000 for each claim. (Authority: 31 U.S.C. 3802 (a) (1)).
This document is available in alternative formats to individuals with disabilities by contacting Disability Support Services at 253-833-9111, ext. 2631; TTY 253-288-3359; or by email at dss@greenriver.edu.
Green River College is an equal opportunity educator and employer. Learn more at www.greenriver.edu/accessibility.
greenriver.edu/enrollment • (253) 833-9111 Ext. 2500 • 12401 SE 320th St., Auburn, WA 98092
enrollmentservices@greenriver.edu • fax (253) 288-3454
