Form Owner:
prairiestate.edu
Step 1 of 2: Submit
Tuition Appeal Form
PSC ID Number
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Full Name
*
Home Street Address
*
Phone Number
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PSC Email Address
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Degree Program
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Academic Year
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Term
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Select an option:
Fall
Spring
Summer
Course(s)
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Write a letter describing the reason(s) and justification for seeking an appeal. Be specific: describe extenuating circumstances, provide dates, the name of persons contacted, and any steps you took to address the problem at the time it occurred. Attach appropriate documentation from your professor(s), medical provider(s), or other professional(s) as needed. Contact the appropriate dean's office for more information.
Reason for Seeking Appeal/Description of Circumstances/Supporting Documentation
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Supporting Documentation
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Supporting Documentation
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Supporting Documentation
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Student Signature
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Date:
Monday, 5 December 2022 (EST)
Name:
Type your name to sign this document:
Typing name is equivalent to a handwritten signature
*
indicates required fields