Tuition Refund Appeal Form

Western Connecticut State University’s policies on refunds of tuition charges can be found on Western’s website at: https://www.wcsu.edu/cashiers/refund/

Students may complete this form after they have formally dropped or withdrawn through the Registrar’s Office and only if there are significant or unusual circumstances outside of their control that causes involuntary withdrawal from any or all classes. This appeal form must be accompanied by supporting documentation and must be completed by the student in accordance with the Family Educational Rights and Privacy Act of 1974 as amended (FERPA). An appeal submitted on behalf of a student (i.e. parent, counselor, doctor, etc.) will not be considered.

Please note: This form is to be used for tuition and fee appeals associated with course registration only. Appeals related to Residence Life (housing and meal plan) charges must be initiated through the Housing Department.

Student Information

First Name

Last Name

Email Address

Student ID Number

The value must be a number (ex. 50212345)

Phone Number

Appeal Information

Academic Year & Semester Appealing

Date of withdrawal filed with Registrar's Office

Amount being appealed

Reason for Appeal

Military Duty: If you have been called into Active Duty, please contact Western's Veterans' Affairs Office.Illness/Injury: Provide a detailed explanation of the situation and include appropriate medical documentation from a physician or hospital.Bereavement: Provide an explanation noting your relationship to the deceased and include documentation such as obituary or funeral notice.Personal Situation: Provide an explanation of the circumstances and include documentation such as legal documents, police report, etc. COVID-19Administrative Error

Please explain the reason for your tuition appeal

Additional Documentation

Student Certification

Decisions will be communicated to students via their provided email address. Students will receive a response within 30 days of submission.

All information provided as part of this appeal is true to the best of my knowledge.

Yes

Please sign by typing your full name below