Guilford Technical Community College
P. O. Box 309, Jamestown, NC 27282
TEL.: 336/334-4822 Greensboro 336/454-1126 Hiogh Point TTY 336//841-2158
Afrmative Action Equal Opportunity College
Student Name:
Telephone Student ID
e-mail address
Last First Middle
Current Address City
Zip Code
Term/Year List course Prex and section # (exp. Eng-111-12) and
- last date of attendance (LDOA) if applicable
I am not receiving nancial aid. (Financial aid includes loans, grants, scholarships and veterans benets).
Course # - Sec. # Course # - Sec # Course # - Sec. # Course # - Sec # Course # - Sec #
_________-_____ _________-_____ __________-_____ _________-_____ _________-_____
LDOA: _________ LDOA: _________ LDOA: _________ LDOA: _________ LDOA: _________
Instructions: You must withdraw/drop courses before petitioning. Tuition refunds are based on the effective withdrawal date. For refund
exceptions, you must notify the VA/Military Assistance Programs Ofce (if receiving VA benets) and the Financial Aid Ofce if you are
a pell grant recipient, scholarship recipient, or work study student. Your situation must fall into one of the listed categories. Check the
appropriate box, attach the required documentation (see below), and return this form and the documentation to the Records Department
(Room 229), Medlin Campus Center, Jamestown Campus.
Deadline: Your request for refund must be within two weeks of the end of the term in question. Submission of this request (even if ac-
companied by documentation) does not guarantee a tuition refund. Requests for tuition refund exceptions based on failure to withdraw
or non-attendance will not be approved.
Reasons For Petition (check all that apply) Documentation (Must be on letterhead)
Medical turn in before the 50% point of the
Letter on letterhead from attending physician describing medical condition
and, if the condition warrants, recommendation of withdrawal of classes.
Letter on GTCC letterhead from college ofce or advisor or email directly to
the Registrar
Curriculum, advisement, or scholastic dismissal
Any documentation you provide will not be distributed to agencies or researchers outside the college.
All reports we make about these requests are in summary form without disclosure of individual data.
If you have read and understood the statement above, sign and date below.
Student Signature:
For Ofce Use Only
Results of Decision
Effective Date: _________
Military Deployment Copy of military orders
I am receiving nancial aid. NOTE: If your circumstances require you to withdraw from all courses, you are encouraged to
contact a Counselor, nancial aid representative, VA coordinator and your academic adviser so your decision will be based on
a clear understanding of the consequences of withdrawing from courses. I understand that in most cases withdrawing from
courses will result in being billed for aid that has been disbursed based on my original enrollment.
yes no
Signature:_______________________________________________________________ Date: _____________________
click to sign
click to edit
State Refund Policy
The college will refund 100% of tuition and fees if you ofcially withdraw from class before the rst day of
classes of the academic semester.
In compliance with current State Board policy: 75-percent of tuition only may be refunded if the student
ofcially withdraws from class(es) on or after the rst day of the start of the semester and prior to or on the
section’s census date. During the drop/add period, if you are changing sections, or dropping and adding a
class—BOTH the drop AND the add transaction MUST be performed in the same registration session in
order to receive full credit for the course you are dropping. Other fees, such as shop/lab/clinic fees, YMCA
fee, GBAT fee, GOLDS fee, RUSH fee, campus access/parking/security fee, computer use/technology fee,
student activity fee, student accident insurance fee, and malpractice insurance fees are not r
efundable after
classes start. The census date of each section may vary and may be obtained from logging into WebAdvisor
and clicking on My Class Schedule. A student may receive a full refund of tuition and fees if s/he ofcially
withdraws from school prior to the rst day of the semester. No refunds will be given to students who drop
a section after the census date of the section.
The college refund policy is established by state legislative action and therefore, is subject to change without
prior notice to students. Please allow 6 to 8 weeks for refunds.
Financial Aid Refund Policy
The Higher Education Amendments of 1998 prescribes the requirement for calculating the amount of
aid a student and school can retain when the student totally withdraws from all classes. Students who with-
draw from all classes prior to completing 60% of the semester will have their eligibility for aid
recalculated based on the percent of the semester completed. For example, a student who withdraws
completing only 30% of the term will have “earned” only 30% of any Title IV aid received.
The remaining 70% must be returned by the school and/or the student. The Financial Aid Ofce
encourages you to read a complete copy of this policy carefully. It is available on our website. If you are
thinking about withdrawing from all classes PRIOR to completing 60% of the semester, you should contact
the Financial Aid Ofce to see how your withdrawal will affect your nancial aid.
It is very important that you ask questions, examine your schedule carefully, and TAKE
RESPONSIBILITY for your schedule!
Check your program in the catalog-- be sure your classes are required if you are working toward a
Transfer students should check to make sure the classes you choose are transferable.
Check campus location where your classes are offered— be sure it is where you want to be.
If you schedule classes on more than one campus— make sure you have time between classes to travel between
Do not sign up for more classes than you want, planning to drop after the rst day of class, unless you are
prepared to accept a 75% refund of tuition only.
If you need to DROP and ADD during the schedule adjustment period, you must do so in one registration session.
That is the only way, your new class and your old class (if the number of credit hours is the same) will
not result in you owing the state money.
Accounts referred to a third party for collection are subject to applicable collection fees.