Appeal of Debt/Tuition/Fee Waiver

Appeal of Debt/Tuition/Fee Waiver
Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Student ID#*
Semester/Year Wavier Requested*
Phone Number *
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Process

Your appeal, along with all relevant college documentation and records, will be reviewed by a committee of Business Office and Student Services staff familiar with the college processes and procedures involved. You will be notified in writing of a decision within fifteen (15) college working days from the date the College receives this request form. The committee's decision will be considered final.
Part I
Who advised/registered you for your course?*
When did you make the decision not to attend your class(es)?*

MonthDayYear
Date
What steps, if any, did you take to notify the college after making the decision not to attend your class(es)?*
Part II
Describe the facts and circumstances that you want this committee to consider.*
Attach additional pages and documentation for Part I & Part II that support your appeal if relevant.

Cancelof
Should be Empty:

Part I