Revised 7/14/20
Refund Policy Petition
Petition Guidelines* *Indicates required field
Please initial next to each guideline to acknowledge your acceptance. Failure to comply with these guidelines may result in the denial of
your petition.
______ I have included a typed and signed personal statement explaining my reason for requesting a refund.
______ If applicable, I have included documentation to support my reason for requesting a refund. Documentation must be
typed on official letterhead, signed, and dated. Examples of documentation include a physician’s note indicating dates of
illness; court documentation; letter from employer stating change in work schedule or official hire dates, etc.
______ I have either dropped or been issued a Y or W grade for all courses for which I am petitioning for a refund. Petitions for
courses that have been issued a grade indicating attendance of the course (A-F, I, P, N, X) will be denied. If you believe you
were issued one of these grades in error, you may contact the instructor for the course to request a change of grade to W or Y.
______ I am submitting this petition within one calendar year of the end of the course(s) for which I am requesting a refund.
The only exception to this deadline is if there was a verifiable institutional error. Not knowing that you registered yourself for
the course(s) does not constitute institutional error.
______ I understand that if I used financial aid funds to pay for the course(s), my financial aid for the term(s) may be adjusted,
possibly increasing the balance owed to CCC. If my petition is approved, I may not be entitled to keep the refund due to the
financial aid adjustment. Contact the Office of Financial Aid and Scholarships if you have questions about this.
______ I understand that I will receive a decision on my petition via email within two weeks of the date it is received. If your
petition is denied, you may submit an appeal to the Registrar within 30 days of the date your denial email is sent.
Petition Criteria
1. Personal illness, injury, or death in the family
2. Change in work schedule or new employment
3. Change in childcare
4. Imprisonment
5. Institutional error
6. Deployed active military (not training)
7. If your reason for requesting a refund does not meet any of the criteria above, or if you do not provide applicable supporting
documentation supporting any of the criteria above, the college may offer a one-time exception. If you have already been
given a one-time exception, your petition will be denied.
Full Name* ______________________________________________ Student ID* _________________________________________
Phone* _____________________________________ Email* _________________________________________________________
Term for which you are requesting refund*: Fall ________ Winter ________ Spring ________ Summer ________
Course Number(s)* __________________________________________________________________________________________
Student Signature* ___________________________________________________________________ Date ___________________
Return completed form to:
EMAIL: registration@clackamas.edu
FAX: 503-722-5864
IN PERSON: Enrollment Services, Roger Rook Hall Lobby
MAIL: Enrollment Services, Clackamas Community College, 19600 Molalla Ave, Oregon City, OR 97045-7998
OFFICE USE ONLY
Approved/Denied by _______________________________________________________________________________________
Comments _______________________________________________________________________________________________
Letter Sent ______________________________________________________________________________________________
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