Tuition Appeal Refund Request

Tuition Appeal/ Refund Request
STUDENT INFORMATION:
BMCC ID
Name

First NameLast Name
Other Last Names Used
Date of Birth

MonthDayYear
Date
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please Indicate the term and year this request applies to. Note: Requests that are more than 90 days past the term and year in which the exception is being requested may not be considered.
Term
Year:
Indicate below what circumstances prevented you from:
- Officially dropping a class during the refund period;
- OR Making payment in full; OR
- Having a tuition installment contract in place before the payment deadline
Please provide the committee with detailed information as to why you are appealing/requestion a refund
Course Number: Indicate which course or courses you are petitioning for. (Example WR 121)
You must provide supporting documentation. All supporting documentation must be signed.

Cancelof
By submitting this form, you acknowledge that the above information is true and accurate to the best of your knowledge.
Student Signature Required
Date

MonthDayYear
Date
Should be Empty:

Tuition Appeal/ Refund Request