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Tuition and Fees Appeal Form

Thursday, July 18, 2024

Please complete the form below and upload all appropriate documentation for review by the Tuition Appeals Committee.


Last, First, Middle

*Appeal Term:
*I am appealing ALL COURSES for the semester:

If NO, complete the following:

Example: ENGL 1301 English Composition I

*Are you requesting an exception due to extraordinary circumstances, such as illness or death in the family? If YES, you MUST upload below all supporting documentation to this appeal (Doctor, therapist, hospital). If supporting documentation is not uploaded, it will typically result in your appeal being denied.
*Are you requesting an exception due to an error by UA – Pulaski Technical College? If YES, you MUST upload a letter from the department that made the error, and explain in the space provided below.
*Did you receive financial aid or VA benefits during the term indicated above?
*If you answered YES to the previous question, have you discussed with the Financial Aid Office and/or the Veterans Services Coordinator the effect of your decision to drop/withdraw and appeal your charges?

IMPORTANT NOTE: Students receiving financial aid should be aware that their financial aid award may be recalculated and adjusted according to their withdrawal date. This can result in a student being ineligible for tuition/fee refunds or accruing a balance on their student account. The appeal process does not negate the student’s responsibility for repayment of loans. Charges to your account by the UA-PTC bookstore are not appealable to UA-PTC. Bookstore refunds are subject to Bookstore policies. Inquiries about Bookstore refunds must be made in person to the Bookstore manager.

I certify that the above information and any attached documentation are correct and truthful to the best of my knowledge,

I understand that typing my full name in this box constitutes a legal signature.

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