CGCE Student Financial Appeal

Westfield State University College of Graduate and Continuing Education STUDENT FINANCIAL APPEAL PETITION FORM *Financial appeals forms must be submitted by students making the appeal. Third-party submissions will not be processed. If you need any assistance at any time during the appeals process, please contact Estelle Camacho at mcamacho@westfield.ma.edu or 413-572-8801. If your appeal is based on the existence of a disability please contact Disability Services at 413-572-5789 or 413-572-8789 for support. Students should submit documentation to verify any extraordinary circumstances. Appropriate documentation includes medical records and doctor’s notes, court/legal records, unemployment statements, etc. The deadline for financial appeals is 10 business days after the term has ended.

First Name	*
Last Name	*
Student ID#	*
Email Address	*
Street Address	*
City	*
State (e.g. MA)	*
Zip Code	*
Home Phone	*
Cell Phone
Program of Study/Major/Course	*
Undergraduate/Graduate	*


An appeal is a formal process. Appeal decisions will be made in accordance with University policy, where applicable. In case of course withdrawal, appeals are almost always denied if the issue is not the responsibility of University faculty, staff, or systems, or the result of documented extreme circumstances. The following reasons are not valid grounds for an appeal: I didn’t know there was a deadline to withdraw. I thought I would be automatically dropped if I didn’t attend or pay for the class. I stopped attending the class, so I want my money back. I never attended the class, so I want my money back. The deadline didn’t give me enough time to decide on staying in the class. I wasn’t doing well in the class. I needed the money for something else. I didn’t have the money to pay for the class.

Please indicate which of the following policies you are appealing (check all that apply). Complete policy details are available on the Westfield State University website and the Westfield State University Bulletin, in conjunction with other CGCE publications:
		Refund (deadline for refund is 10 business days after term has ended) Other (please specify below)


What term does this appeal apply to:	*
What year does this appeal apply to:	*

Please use the space below for a statement of justification explaining the grounds of your appeal. If your appeal is based on the existence of a disability please contact Disability Services at 413-572-5789 or 413-572-8789 for support. Students should submit documentation to verify any extraordinary circumstances. Appropriate documentation includes medical records and doctor’s notes, court/legal records, unemployment statements, etc. It is your responsibility to provide proof that your appeal is justified; incomplete or inaccurate information will result in denial of your appeal. Be specific – include course information and instructor (where appropriate), semester, dates, etc. In addition, wherever possible, attach below any documents validating your statement. Relevant email may be copied /pasted into the field below or forwarded separately from this appeal form to mcamacho@westfield.ma.edu. Any documents that cannot be attached electronically may be forwarded to Estelle Camacho, 577 Western Avenue, Westfield, MA 01086. Please be aware that all details in your statement will be verified.
	*
Attach additional documentation
Attach additional documentation
Attach additional documentation
	*	I hereby attest to the accuracy of the above statement. I understand that it is my responsibility to provide proof that my appeal is justified, and that incomplete or inaccurate information will result in denial of my appeal.
	*	I understand that this appeal may take up to one month to process, that all decisions are final, and that I will be notified of the outcome via the email address that I provided above.
Signature (Please type your full name here):	*
Accessibility & Inclusion