University of Maine at Augusta

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Student Tuition & Fees Appeal Form

THE UNIVERSITY OF MAINE AT AUGUSTA
Student Appeals Committee
Attn: Student Financial Services
46 University Drive, Augusta, Maine 04330
Info Center: 1-877-862-1234 or 207-621-3412
FAX: 207-621-3384

STUDENT APPEAL FORM
(Complete and return to address above)

NAME: ____________________________________________________STUDENT ID #:___________
___________________________________________________________________________________
(address)
____________________________________________________________________________________
(city)      (state)         (zip)                          (phone)
APPEAL REQUEST:
TERM:_________________ YEAR:_________ APPEAL AMOUNT:$_______
(fall, spring, summer)
_____Withdrawal (All classes)
_____Dropped

Course(s)_____________________________________________________
INVOLUNTARY APPEAL REASON (Please attach appropriate documentation substantiating your request. Student Appeal Forms without appropriate documentation will not be considered complete and therefore not reviewed by the Appeals Committee):
_____Active duty in the armed services
_____Illness: Student____ Family Member______________________
_____Death: Student____  Family Member______________________
_____Employer Transfer:     Employer__________________________
VOLUNTARY APPEAL REASON:
Please attach a letter detailing your reasons for requesting an exception to University drop/withdrawal policies. Please be as specific as possible; include instructor corroboration if appropriate.

Last date attended: __________________________ Course: ________________

I hereby request consideration of my appeal to reverse tuition and fees presented above. I attest that the statements and accompanying documents are true. I understand that my appeal determination may adversely affect previously approved financial aid (including aid payments I have previously received) and I may owe a balance to the University of Maine at Augusta if federal aid is retracted.
________________________________________________________________
Student Signature/Date

University of Maine at Augusta