Petition for Consideration of
Exception to Policy

Return to: UNIVERSITY OF UTAH INCOME ACCOUNTING
201 S 1460 E RM 165
Salt Lake City, UT 84112-9054
Fax: (801) 585-3898
Please Print Legibly:

Name Date
Address ID#
City/State/ZipPhone

This form is provided only as a mechanism by which your request can be processed by cognizant University officials. It in no way implies that approval is forthcoming. Since the burden of proof rests with the student, documents and/or statements supporting the request such as, letters from instructors on department letterhead stationery attesting to attendance or non-attendance, statements from physicians on letterhead stationery, should be attached. You must be officially withdrawn from all classes considered on this petition. Please submit petition only when all documents have been obtained.
I have read and understand policy and instructions for completing Petition for Consideration of Exception to Policy.

Signature:

[ ] Tuition Refund/Waiver Request
[ ] Late Payment Fee Refund/Waiver Request 		Semester & Year:

If request involves a specific course, please complete the following:
Semester & Year Department Course No. Section No. Credit Hours

State the reasons for your request:

  1. Exceptions to the refund or tuition payment policy

    Depending on a student's circumstances, exceptions to the refund or tuition payment policy may be made for unusual/hardship cases. Supporting documents from agencies, departments, physicians, etc., substantiating the claims should be attached to the petition.

  2. Exceptions to waive late payment fee

    Petitions will only be considered in cases with extenuating circumstances, properly documented, and in cases of University error.

  • Please be aware that the burden of proof rests on the petitioner.
  • You must furnish all of the necessary documents to support your case.
  • Please staple any pertinent letters or documents to this form.

Do not write in this box; for office use only. Comments:

This petition for exception to University policy has been:

[ ] Approved [ ] Denied [ ] Pending Date: ______________________________