Appeal to the Fee Reassessment Committee

First Name:

Last Name:

Email address:

Address:

City:

State:

Zip:

KU ID:

Daytime telephone:

Evening telephone:

A. I understand that, based on my submitted petition, I have been denied a fee reassessment.
B. I further understand that I have the right to appeal this decision.
C. I hereby, appeal this decision by requesting that my Petition for Fee Reassessment be reviewed by the Office of the Registrar, and if again denied, be presented to Appeal Committee for review.
D. I wish to present the items listed below as new and/or additional information for consideration.

Explanation:

INSTRUCTIONS:
PLEASE BE SURE TO PROVIDE ALL REQUESTED INFORMATION. Explain why you want your assessment considered, when you discovered the situation, and how the situation was discovered by you. Also, please identify who you have worked with to resolve the problem. Be as specific as you can. If any documentation is available to support your case please bring, mail, FAX ,or e-mail the documents to :
University of Kansas Medical Center
Office of Registrar
Mail Stop 4029
3901 Rainbow Blvd.
Kansas City, KS 66160.
FAX: (913) 588-4697
kumcregistrar@kumc.edu

Supporting documentation may include items such as letters from physicians to verify illnesses or injuries, printed material from KUMC which led you to be misinformed, letters fr m someone who gave you misinformation, etc. Failure to provide supporting documentation will delay the decision regarding your petition. You will be notified of a decision within thirty days of the date of submission.

I have read the above statement.

I certify that the information on this Appeal of Fee Reassessment is correct and that the information on my Petition for Fee Reassessment is still correct.

Date:

 

Last modified: Feb 21, 2014
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