Adjustment Request Form Page 2

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Bursar’s   O ffice  
863.874.8406 | Room 1103
4700 Research Way
Lakeland, FL 33805-8531
 
4. University  error,  confirmed  by  the  appropriate  University   o fficial  in  writing  on  official  University
College/Department  letterhead.  Please   n ote  that   a lthough  the  University   h as  a   m andatory   f irst   d ay
attendance  policy   a nd  faculty   m ay   d rop  them  from  the  rolls  and   r egistration   f or  the  course,   i t   i s  the
student's  sole  responsibility   t o   e nsure  they   d rop  to   a void  fee  liability.   A   f aculty   m ember's  failure  to
exercise  the   r ight   t o   d rop   a   s tudent   f or   f ailure   t o   a ttend   t he   f irst   d ay   o f   c lass   i s   N OT   U niversity   e rror
and   w ill   n ot   b e   j ustification   f or  a   r efund.
5. Other  exceptional  circumstances  beyond  the  control  of  the  student  that  preclude  completion  of  the
course(s).  Submission  of  an   explanation  letter  from  the  student  must  be  accompanied  by  written
OBJECTIVE  and  verifiable  documentation  supporting  the  student's   claim  of  exceptional
circumstances  beyond  his/her  control.
CRN  
PREFIX  
NUMBER   SECTION   HRS.  
CRN  
PREFIX  
NUMBER   SECTION   HRS.  
Signature:       _ _______________________________________________________   Date:  ___________________  
For   O ffice   U se   O nly  
Approved:  
Hours   a pproved:     _____________________________  
Denied:  
Reason   f or   D enial:     ____________________________  
 __________________________________________________________________________________________  
Official   S ignature:  ______________________________________________________  Date:  ___________________  
2  

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