CEWD Student Request for Drop/Refund

CEWD Student Request for Drop/Refund

Continuing Education & Workforce Development
Student's Name*

First NameLast Name
Student's Email*
example@example.com
Student ID #*
Date of Birth*

MonthDayYear
Best Contact Number*
Enter the best number where we can contact you.Format: (000) 000-0000.
Home Address*
City*
State*
Zip Code*
County*
Type of Request*

DropDrop & Refund
Check the reason for your request*

Personal illness: Requires dated medical documentation.Family issues: Requires documentation of event with dates, newspaper articles, court documents, etc.Job change: Requires signed letter on company letterhead.Military: Provide copies of orders, DD214, etc.Other
Course Information
Course(s)*
Supporting Documentation
1. Provide supporting documentation including, but not limited to, a letter from your medical provider, court documents, or military orders. These papers must include dates relevant to your appeal. You must prove that you were unable to complete your class(es).

REQUIRED if requesting Drop & Refund
Cancelof
2. Provide a statement in the box below to explain the details of your appeal.
REQUIRED if requesting Drop & Refund
Signature and Acknowledgement

Student or Parent/Guardian Signature
Select your preferred signature method:*

Typed (enter your name)Drawn (use your mouse or touch screen)
Name

First NameLast Name
Signature

Clear
Date*

MonthDayYear
Please allow 10 business days for us to review and process your request.
Frederick Community College
7932 Opossumtown Pike • Frederick, MD 21702
301.846.2400 • frederick.edu

Frederick Community College (FCC) prohibits discrimination against any person on the basis of age, ancestry, citizenship status, color, creed, ethnicity, gender identity and expression, genetic information, marital status, mental or physical disability, national origin, race, religious affiliation, sex, sexual orientation, or veteran status in its activities, admissions, educational programs, and employment. Under the ADA and Section 504, FCC makes every effort to accommodate individuals with disabilities for College-sponsored events and programs. For FCC employees needing accommodations, including interpreting, email humanresources@frederick.edu. For students and others with accommodation needs or questions, call 301-846-2408, or to request sign language interpreter services, please email interpreting@frederick.edu. Sign language interpreters will not be automatically provided for College-sponsored events without a request for services. Requests must be made at least five workdays before a scheduled event to guarantee accommodations. If your request pertains to accessible transportation for a College-sponsored trip, please submit your request at least 21 calendar days in advance. Requests made less than 21 calendar days in advance may not be able to be guaranteed.
frederick.edu/accommodations
4/14/26
Should be Empty:

CEWD Student Request for Drop/Refund

Course Information

Supporting Documentation

Signature and Acknowledgement