75.59(C) revised 9/20/2019
Name: Student ID:
Employment-A letter from your employer, on company letterhead, indicating that your
employer changed your work schedule and that this change prevented you from
completing the term. The letter must include old and new work hours and the effective
Death (Immediate Family Member or Guardian)- one of the following; an original death
certificate, newspaper notification, or obituary. It is your responsibility to establish your
relationship to the deceased individual
Active Military Duty- must include a copy of orders.
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
withdraw from your course(s).
Other Circumstances: Other circumstances are those required by a regulatory agency.
Submit documentation that supports the regulatory agency requirement and your
statement(s) in your letter.
Financial Hardship: The exception for financial hardship may be granted only after the
student has demonstrated reasonable effort to succeed in the class. Explain how paying
the full cost of instruction impacts your financial circumstances. In determining your
financial need, you should include the following: employment hours per week; where
you obtain the funds for your educational costs (work, savings, other); student status
(full-time or part-time); number of dependents, whether you are receiving Federal need-
based financial aid.
Complete the information below for the course(s) which you are appealing the full cost of tuition (out
of state tuition) due to extenuating circumstances:
Course Title Course Prefix Course # CRN (5 digits)
Deadline: NO APPEAL will be considered AFTER the first day of classes for the semester this
exception is applicable.
I understand that:
When taking any course for the third time, I may not exercise the option to withdraw, but
must complete the course and be assigned a grade, as specified in SBE Rule 6A-14.0301. I
also understand that “students who withdraw or fail a class due to extenuating circumstances
may be granted an exception only once for each class” (FS 240.124)
Appeals received without proper documentation will be returned and not reviewed until proper
documentation is provided to the Committee and this could jeopardize the timeliness of the
It is my responsibility to monitor my FKCC email account for any correspondence from the
committee regarding this appeal.
The Committee has the right to seek relevant input regarding this appeal from other college
departments, including instructors, and use this information in their decision-making.