Continuing Education (Non-Credit) Tuition and Fees Refund Appeal Form

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Continuing Education (Non-Credit)
Refund and Transfer Appeal Form

JCCC ID:

Last Name:

First Name:

Street:

City:

State:

ZIP:

Daytime Phone #:

Email:

Term:

Year:

Course Code

Course Title

Date

Fee

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All appeals must be accompanied by an explanation of circumstances written by the student. Include any supporting documentation, such as a doctor’s statement written on the physician’s letterhead, employer’s statement written on letterhead, or any other information that would be proof of extenuating circumstances listing specific dates of incidents.

CE Refund Policy: A full refund will be made if the college exercises its right to cancel class or if the class is full when a registration is received. All checks will be deposited and a refund issued by the college. Other refunds will be honored if a cancellation request is received in the JCCC Continuing Education Registration office four business days before the class begins. If payment is made by cash or check, JCCC will mail the refund to the student. Credit card refunds will be credited to your charge account. Please allow 7 to 10 business days. Exceptions to this policy may be authorized by the Dean of Continuing Education.

I am requesting to be:

Student's Explanation:

Do you need to attach documentation?

I have read the instructions on this form and have attached all supporting documentation. I realize the appeal will not be considered if the student’s explanation and/or supporting documentation is not attached.

Nondiscrimination Statement: JCCC provides equal opportunities and equal access to all individuals and is an affirmative action employer. JCCC does not discriminate on the basis of sex, race, color, national origin, ancestry, disability, age, religion, marital status, parental status, military status, veteran status, sexual orientation, gender identity, genetic information or other factors that cannot be lawfully considered in its programs fand activities, which includes employment and admissions, in accordance with Titles VI and VII of the Civil Rights Act of 1964, the Equal Pay Act of 1963, the Age Discrimination in Employment Act of 1967, the Age Discrimination Act of 1975, Executive Order 11246, Title IX of the Education Amendments of 1972, Section 503 and 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act, the Vietnam Era Veteran’s Readjustment Assistance Act, the Jobs for Veterans Act of 2002, the Kansas Acts Against Discrimination and all other applicable civil rights and nondiscrimination laws.

Inquiries concerning JCCC's compliance with its nondiscrimination policies (including Title IX, Title VI and Section 504 inquiries) may be referred to a Title IX Coordinator (TitleIX@jccc.edu), or Director of Human Resources, or the Dean of Students and Learner Engagement at Johnson County Community College, 12345 College Blvd, Overland Park, KS 66210, 913-469-8500; or to Office for Civil Rights, Kansas City Office, U.S. Department of Education, One Petticoat Lane, 1010 Walnut Street, Suite 320, Kansas City, MO 64106, Telephone: 816-268-0550, Facsimile: 816-268-0559, Email to: OCR.KansasCity@ed.gov.

OFFICE USE ONLY:

CE Registration Comments:

Program Recommendation:

____ Refund/Transfer Request Approved

____ Refund/Transfer Request Denied

Comments:

Administrative Approval:

____ Refund/Transfer Request Approved

____ Refund/Transfer Request Denied

Comments:

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