Student Appeal for an Emergency Withdrawal or Tuition Refund
Student Name: ______________________________________________ Student ID# ___________
Mailing Address: __________________________________________________________________
Contact Phone: ____________________ Email Address: __________________________________
The Emergency Withdrawal and Tuition Refund Policy can be found online at:
https://www.csmd.edu/about/policies/involuntary-withdrawal-policy.html.
What type of appeal are you requesting?
Retroactive drop to the refund period
You are requesting to drop your courses without any grades appearing on your transcript. The
tuition charges for the courses will be removed from your account, however you will still be
responsible for payment of any non-refundable fees and any accrued charges such as bookstore
purchases.
Late withdrawal
You are requesting to withdraw from courses. A grade of WD will appear on your transcript. You
are still responsible for the tuition for the courses including any balance after financial aid
adjustments as well as any non-refundable fees and any accrued charges such as bookstore
purchases.
Adjustment of tuition charges
You are requesting an adjustment to your tuition charges. There will be no changes to your
registration status (i.e. you remain enrolled in the courses).
Do any of the following apply?
Financial Aid Recipient
Veterans Education Benefits Recipient
Employer Tuition Assistance Recipient
Course information (example: Fall 2020, HST-1032-87654
Term / Year: _______________ Course & Section Number _____________________
Term / Year: _______________ Course & Section Number _____________________
Term / Year: _______________ Course & Section Number _____________________
Term / Year: _______________ Course & Section Number _____________________
Term / Year: _______________ Course & Section Number _____________________
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Reason for Appeal
Illness of student or immediate
family member– (Immediate family includes, a spouse, parent,
child or other member of the student’s household.) Certification must be provided by the student's
or family member's attending physician stating that the student's or family member's illness
requires the student's withdrawal. Physician’s note must be on professional stationary, specify
dates of treatment, and clearly indicate that ill health made it impossible for student to continue
enrollment in classes.
Military deployment – Must provide copies of military orders signed by the individual's
commanding officer or another appropriate official to show proof of effective date.
Death of student or immediate family – (Immediate family includes, a spouse, parent, child or
other member of the student’s household.) Appropriate substantiation must accompany the
request for withdrawal. Examples include a death certificate, notice, newspaper article, or funeral
program. Relationship to student must be clearly indicated in documentation.
Involuntary change/transfer in work hours – A letter from the supervisor must be provided
and appear on company letterhead, indicate effective date of change in work schedule, and outline
new work schedule.
Other – These appeals require highly extenuating circumstances that were outside of the students'
control. Be thorough in explaining in your statement.
Please submit your appeal, explanation of the situation and required supporting documentation to:
Email:
Mail:
In Person:
Student Appeals – REG, PO Box 910, La Plata MD 20646
La Plata:
Information Desk, AD Building Lobby
Prince Frederick: Welcome Center, PFA Building Lobby
Leonardtown: Welcome Center, C Building Lobby
By submitting this form, I am confirming that I understand that College of Southern Maryland only grants
registration appeals under extraordinary circumstances. It is the student’s responsibility to drop his or her
courses prior to the established deadline. After the published deadline, appeals to the policy must be made
by using this form and submitting it as indicated above. A written statement of explanation and
supporting documentation must be included. Appeals without supporting documentation will be denied.
Refunds are generally not granted if the student’s tuition balance has been sent to the State of Maryland’s
Central Collection Unit (CCU).
If your emergency withdrawal or tuition refund is approved, you may receive a pro-rated refund of tuition
based on your date of withdrawal, last date of attendance, and/or effective date of your situation as
documented above. Please allow 3-4 weeks from submission to receive notification of the student appeals
committee decision.
Signature: ______________________________________ Date: ________________
