Tuition Appeal Form

Students Name Students Name First Last
Other Name(s) Used
Student ID #

Your L#
Phone Phone - ### - ### ####
Email
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Term Year
Term Semester
Reason for Appeal
I understand that the explanation letter MUST accompany this form for consideration.

I understand that the explanation letter MUST accompany this form for consideration. Yes No
Attach the Letter of Explanation

Attach Files
Attach Additional Documentation

Attach Files
I understand that I will be notified of the decision regarding my appeal through the email and mailing address I provided.

I understand that I will be notified of the decision regarding my appeal through the email and mailing address I provided. Yes No
If I receive financial aid and this appeal is approved, I understand that it may reduce or cancel my financial aid.

If I receive financial aid and this appeal is approved, I understand that it may reduce or cancel my financial aid. Yes No
Acknowledgement
My signature indicates that I certify that all information entered above is correct.

Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Today's Date Today's Date / MM / DD YYYY
If you require assistance to complete this form, please call Student Billing at (318) 345-9007 or send an email to studentaccounts@ladelta.edu.

Tuition Appeal Form

Tuition Appeal Form

If you require assistance to complete this form, please call Student Billing at (318) 345-9007 or send an email to studentaccounts@ladelta.edu.