Student Appeal Request

Student Name(Required)

First Last

Student Current Address(Required)

(NCC will use this mailing address to notify you of the appeal results.)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

NCC Student ID Number

Student Email(Required)

Appeal results will be emailed to this address.

Student Phone(Required)

Please provide a phone number that you will answer.

Advisor Name

First Last

Academic Program

Next Term of Enrollment(Required)

Fall

Spring

Summer

Unknown

Current Housing Student?(Required)

Yes

Requests with the following circumstances do not usually represent a sound basis for an appeal:

Personal error in judgement involving availability of finances, academic ability, or time management; lack of knowledge or disregard of withdrawal policies and refund deadlines
Situations that indicate the student ignored prior correspondence (mail / email / texts / voice messages), failed to ask questions or to take steps to resolve prior to the submission of this form
Inability to pay; including inability to pay as a result of an incomplete financial aid application or lack of funding from financial aid

Indicate below the category of your appeal (check all that apply)(Required)

Request to withdraw after the withdrawal deadline

Academic Suspension status

Request a Tuition / Fee Refund

Request a Housing Refund

Request to enroll even though I have an unpaid, past due bill

Other

If you received Financial Aid for the term in this appeal, be aware that the submission of this form could impact your Financial Aid and result in money owed. Partial or full refunds may require the return of financial aid funds that were used to pay the costs for the term. It is recommended that you discuss these implications with the Financial Aid Office before submitting this appeal request.

List the courses impacted with this appeal request:(Required)

Course Name/Number

Term

Year

Did you use any personal funds to pay for these courses?(Required)

Yes

Did you receive grant, loan, or other financial assistance to pay for these courses?(Required)

Yes

Are you in default on any federal student loans?(Required)

Yes

Are you currently on Financial Aid Warning or Financial Aid Suspension status?(Required)

Yes

You must contact the Business Office within 2 business days of submitting this Appeal Request Form. You will need to discuss payment arrangements and have a payment plan in place.

stop by the Business Office to discuss
call 800-352-4907
Email

Provide Narrative to address the following:(Required)

Circumstances relating to your request

Reason you should be granted a withdrawal grade after the withdrawal deadline

Reason you should be allowed to continue enrollment after being placed on Academic Suspension

Reason you should not be held responsible for the balance due / housing deposit / housing fine

The attempts you have made to resolve the balance due / housing deposit / housing fine

Reason you should be allowed to enroll even though you have an unpaid past due bill

What will be different if you return to NCC for a future semester of enrollment

Documentation:

You are encouraged to submit documentation on appropriate official letterhead which supports your claim for an appeal. Documentation may include statements from your health care provider, email correspondence, statements from instructor/employer, obituary/death certificate, verification of successful semesters at other institutions, military orders.

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.

Student Signature(Required)

By submitting this form, I:

declare that all statements made herein and any attachments are true and correct.

authorize NCC officials to seek additional information and to conduct whatever investigations may be necessary in considering this request.

understand that the changes I am requesting may affect my Financial Aid and/or student account, and the changes may not be in my favor. After a decision has been made, I will accept responsibility to pay the amount due on my account and acknowledge that the amount I currently owe may now increase. I agree to contact the NCC Business Office to discuss payment arrangements.

have provided a current and accurate mailing address, email address and phone number on this form.

understand a final decision will be mailed and emailed to me by the appropriate NCC designee.

CAPTCHA

Requests with the following circumstances do not usually represent a sound basis for an appeal:

By submitting this form, I:

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