Tuition & Fee Refund Appeal

Effective September 22, 2014, appeal requests must be made within 90 days of the end of the semester which you are appealing and must include appropriate supporting documentation. You can submit your documentation at the bottom of this form.

Name Name * First Last
Student UTA ID # *
Current Address Current Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Daytime Phone *
Semester for Which Refund is Requested *
Year for which semester is required *
Classification *
Course(s) *
Supporting Documents *

Supporting Documents Yes No
In the space below, explain why you are requesting that an exception be granted to the state refund policy for universities. *
It is recommended that you upload your supporting documentation here. You can also mail supporting documents to:

Office of the Registrar

Attn: Tuition & Fee Refund Appeals
Box 19088
Arlington, TX 76019

Upload Supporting Documents (Upload documents in .DOC, .PDF, or .JPG format. Please no zip files or heic files.)

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Government Issued Photo ID/ UTA ID *

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By checking the "Acknowledge" box below and submitting this form you acknowledge that you understand the following:

*If a tuition refund appeal is granted, all academic coursework for that term will be removed from my record regardless of the grades I received in the courses.

*The University is only able to approve one tuition refund appeal during my entire academic career at UT Arlington. This includes all voluntary and involuntary separations. In particular, if the event is related to a medical condition, then it is my responsibility to make an informed decision, which may require consultation with a physician and my academic advisor, prior to enrolling in future coursework since an appeal is granted on a one-time basis for a given medical condition. While I will not be granted a second tuition and fee refund, I may have the opportunity to withdraw from coursework with a grade of W or Q in future semesters, assuming I meet all appropriate deadlines and regulations related to withdrawal.

*If I received financial aid including scholarships, grants, or loans for the semester a tuition refund appeal is approved, all of the financial aid I received for that term will be returned to the original source of the funds and I may be required to repay any refund I received from Student Accounts of financial aid that exceeded my direct university charges. Repayment must be made within 45 days of the appeal being granted.

*Appeals older than 90 days or those submitted without supporting documentation will not be reviewed.

Within 21 business days after the appeal form & all documentation is received, the Reinstatement Appeal Committee will issue a decision on the appeal.

DECISIONS BY THE APPEALS COMMITTEE ARE FINAL. *

By checking the "Acknowledge" box below and submitting this form you acknowledge that you understand the following:

*If a tuition refund appeal is granted, all academic coursework for that term will be removed from my record regardless of the grades I received in the courses.

*The University is only able to approve one tuition refund appeal during my entire academic career at UT Arlington. This includes all voluntary and involuntary separations. In particular, if the event is related to a medical condition, then it is my responsibility to make an informed decision, which may require consultation with a physician and my academic advisor, prior to enrolling in future coursework since an appeal is granted on a one-time basis for a given medical condition. While I will not be granted a second tuition and fee refund, I may have the opportunity to withdraw from coursework with a grade of W or Q in future semesters, assuming I meet all appropriate deadlines and regulations related to withdrawal.

*If I received financial aid including scholarships, grants, or loans for the semester a tuition refund appeal is approved, all of the financial aid I received for that term will be returned to the original source of the funds and I may be required to repay any refund I received from Student Accounts of financial aid that exceeded my direct university charges. Repayment must be made within 45 days of the appeal being granted.

*Appeals older than 90 days or those submitted without supporting documentation will not be reviewed.

Within 21 business days after the appeal form & all documentation is received, the Reinstatement Appeal Committee will issue a decision on the appeal.

DECISIONS BY THE APPEALS COMMITTEE ARE FINAL. Acknowledge