In keeping with Florida Statute 1009.285 and BOT Regulation 7.001 (11) for fees associated with the third attempt of an undergraduate
course, using this form, you may apply for consideration of a refund of the Repeat Course Surcharge (RCS) fee only once for each class,
within six months of the end of the application term. You must meet one or more of the approved State defined conditions below.
(NOTE: This is a separate process from the ARC petition.)
Name __________________________________________________________ USFID Number _________________________________
Address ___________________________________________________________ Phone _____________________________________
City/State/ZIP ____________________________________
Summer Fall SpringTerm Year ________
Have you filed a Repeat Course Surcharge
in the past? Yes No
Identify the repeat course for which you are requesting an adjustment:
CRN Subject Number Section Credit Hours
Example: 82189 ENC 1101 081 3
Select the condition(s) that applied to previous attempts of the listed above:
Student illness of such severity or duration that precludes course completion; supply confirmation on letterhead from your medical
provider OR an ARC Medical Form completed by your medical provider.
Death of student or an immediate family member (parent, spouse, child, sibling, or grandparent) confirmed by documentation
indicating the student’s relationship to the deceased; supply obituary or death certificates.
Active military duty or return from active duty confirmed by military orders.
USF System error confirmed in writing by an appropriate USF System official or by appropriate official USF System documents.
Due to reasons of financial hardship; the criteria used for determining financial hardships includes, but is not limited to, qualification
for federal need-based financial aid. Other documented financial hardships may also be submitted for consideration
(i.e. tax transcripts).
Course repeated as a requirement of a major; exceptions to this section are for individualized study, elective coursework, courses that
are repeated as a requirement of a major, and courses that are intended to continue over multiple semesters, EXCLUDING the repeat
of coursework more than two times to increase grade point average or to meet minimum course grade requirements.
Other documented exceptional circumstances beyond the control of the student accompanied by letter of explanation and appropriate
documentation to support claim.
Sign and submit this form with written explanation and supporting documentation to the Office of the Registrar on your campus.
Student Signature ___________________________________________________________ Date ____________________________
PLEASE NOTE: This process can take up to 30 days from the date of submission for the committee’s decision and processing
of the paperwork to be completed. You will be notified of the decision via USF email.
FOR OFFICE USE ONLY
Decision:
Approved
Denied
Repeat Course Surcharge Adjustment
Waiver Request
Tampa Campus
4202 E. Fowler Ave., SVC 1034
Tampa, FL 33620
St. Petersburg Campus
140 7th Avenue S., BAY 102
St. Petersburg, FL 33701
Sarasota-Manatee Campus
6350 N. Tamiami Trail, SMC C107
Sarasota, FL 34243
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