Fillable Student Refund/Late Withdraw Request (Palm Beach State College)

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Student Refund/Late Withdraw Request (Palm Beach State College)

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Student Refund/Late Withdraw Request
A student who must withdraw or is dropped from a class due to a College error/change or other
College action after the published add/drop period shall be refunded 100% of refundable fees upon
the approval of the student’s refund request. No grade is recorded on the student’s record. No other
refunds are granted except in those cases where a student withdraws from classes due to a personal
emergency beyond the student’s control.
Students may withdraw from course(s) online through Pantherweb. A grade of W will be denoted on
the student’s transcript for a withdrawn class. Students are permitted a maximum of two attempts
and/or withdrawals per course. Withdrawals are considered an attempt, which could impact student’s
financial aid status. The deadline to withdraw for each enrolled course is listed on the student’s Class
Schedule; however, a withdrawal after this date may be considered in cases of certain extenuating
circumstances. No refunds are granted for withdraws.
The refund/late withdraw process takes approximately four to six weeks. If you are no longer
attending and it is within the timeframe to do so, it was your responsibility to withdraw from the
course(s). SUBMITTING A REFUND REQUEST FORM DOES NOT OFFICIALLY WITHDRAW YOU FROM A
CLASS OR THE COLLEGE.
Decisions will be based on the documentation provided. You will be notified in writing of the Appeals
Committee’s decision. If approved, your refund will be issued in the same method of payment originally
submitted. Any financial obligations owed to the college will be deducted from your refund. Please
note that requests will not be granted beyond one calendar year from the term in question.
Supporting documentation, as indicated below, MUST be attached to and submitted with this request.
Documentation should indicate that the event/situation cited occurred during the same time frame as
the courses in question.
Medical – a letter from your physician or health care agency, on company letterhead,
specifically indicating an illness of such severity or duration that prevents you from
continuing in your course(s). The letter must include dates of the illness and treatment.
Employment – a letter from your employer, on company letterhead, indicating that your
employer changed your work schedule and that this change prevents you from completing
the term. The letter must include old and new work hours and the effective date.
Death of Immediate Family Member – documentation of the death and your relationship to
the deceased. Immediate family members are limited to spouse, child, parent and sibling.
College Change or Error– a letter from the appropriate college official documenting the
situation in which the college was in error or initiated an action that caused you to have to
withdraw.
Military Service -- Documented involuntary call to active military duty.
Student Refund/Late Withdraw Request
APPROVAL OF THIS REQUEST MAY RESULT IN THE STUDENT OWING THE
COLLEGE A BALANCE.
If approval will generate a balance, would you still like this request to be considered?
□ No □ Yes, unless the balance is more than $_______________
PLEASE PRINT:
Term of Request: □ Fall □ Spring □ Summer Year___________
Student ID ______Name______________ ______
Mailing Address ______
City State Zip Phone:
Please check all that apply for the term of request:
□ Financial Aid Student □ Receiving Veteran Benefits □ International Student (F1 Visa)
Course(s) for request
Reference Number
Course Title
ATTACH JUSTIFICATION FOR REQUEST (See other side for details)
STUDENT SIGNATURE:_____________________________________________DATE:_________
FOR OFFICIAL USE ONLY:
Initial Decision/Campus Recommendation:
Campus F/A Office □ Approved □Denied
Student will Owe: $
F/A Signature:
Campus Registrar □ Approved □ Denied
Registrar Signature:
Secondary/Final Decision:
Committee: □ Approved □ Denied
Committee Rep Signature:
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Student RefundLate Withdraw Request (Palm Beach State College)

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Completed 23 July 2020

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