Petition for Fee Reassessment

This application is for:
First Name:
Last Name:
Email address:
Address:
City:
State:
Zip:
KU ID:
Daytime telephone:
Evening telephone:

Choose the assessment(s) you wish to have reconsidered:
	$50.00 Late enrollment fee
	$100.00 Late enrollment fee

	100% Tuition refund
	90% Tuition refund
	50% Tuition refund
	Other

Please contact Student Financial Accounting about the $100 late payment fee.

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 :
KUMC
Office of Registrar
MS 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 ten business days of the date of submission.

I have read the above statement

Date:

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