Student Financial or Physical Hardship Appeal Form

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Admissions and Records

Home 禄 Admissions and Records 禄 Student Financial or Physical Hardship Appeal Form

Name *

First

Middle

Last

Prior Name(s)

First

Middle

Last

JALC Student ID *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Telephone/Cell Number *

DOB (MM/DD/YYYY) *

Email Address *

Confirm Email

Request

Justification *

You may attach up to three documents to support your justification. Please attach documents as either a Microsoft Word document or an Adobe PDF document. The maximum file size for each document is 10 MB.

Supporting Document(s)

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Verification *

By checking this box, you are signing this document electronically and you verify that the information provided is accurate and true.

This form takes 4-6 weeks to be reviewed. An email will be sent to the student鈥檚 Volmail account after a decision has been made.