Tuition and Fees
Adjustment Appeal
Student’s Name (Last, First, M.I.) Student NECC ID Number
Current Address Phone Number
This form is to be used to request an adjustment of tuition charges due to extenuating circumstances that
affected your ability to complete your class(es) in a given semester.
Term: Appeal DEADLINE
Spring ____ (Jan. May.) September 1
Summer ____ (May.- Aug.) November 1
Fall ____ (Sept Dec.) April 1
Reason for appeal: Medical/Accident Death in the familyMedical/Accident (family member)
   Military Deployment Personal Circumstances
Other: ___________________________________________
To submit an appeal, you must:
Complete all of the information on this form.
Submit the following, attached to this appeal form:
Typed, signed and dated Personal Statement explaining what extenuating circumstances prevented you from
completing your course(s).
Any essential documentation to support the appeal (if applicable) Please note: Documentation should be
official/on letterhead from the source.
Course(s) I am requesting an appeal for:
Course Number
Subject Code
Section Number
Course Title
Required acknowledgments (read and check each statement):
I understand that submitting an appeal does not guarantee an adjustment of charges.
I understand that should the appeal be approved I could continue to have a balance that I am responsible to pay.
I understand that if I received Financial Aid I should contact the Financial Aid Office to determine how this request
will affect my eligibility.
CERTIFICATION: By signing below I acknowledge that I have read and understand the requirements of this appeal.
Submission of an appeal does not guarantee approval.
The information provided with this appeal is complete and accurate. Otherwise, it is not accepted.
An incomplete appeal will be denied if additional information is not received by date requested (two weeks).
All appeal decisions will be sent via mail to the above address within 3 weeks of submittal.
Student Signature_____________________________________________________Date____________________________