DIS Refund Appeal Form

DIS Refund Appeal Form
Before completing this appeal form, review the DIS Cancellation and Refund Policy and communicate with your home institution to discuss your options. Please contact the DIS Refund Appeal Committee at refundappeal@disabroad.org with questions.

The deadline for your appeal is no later than one month after your official cancellation date. Appeals for refunds will not be approved for reasons of failure to cancel or for non-attendance. Furthermore, if you are still enrolled at DIS, or plan to receive a transcript, you are not eligible for a refund.

If you decide to proceed with an appeal, you must submit the following:
1. Student Information
2. Reason for Appeal & Documentation
3. Personal Statement
4. Student Certification
The decision regarding your appeal will be communicated to you or to your home institution, depending on which party was invoiced for your program fees, within 30 days after all items above are submitted.

Decisions will not be available over the phone. Decisions are final.
SECTION A: Student Information
Name*

First NameLast Name
Home University*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Term/Year of Cancellation (Please include session(s) for Summer, if applicable)*
SECTION B: Reason for Appeal & Documentation
Please select the option that corresponds to the reason for your appeal*

Change in Health [Mental, Physical, Emotional, etc.]Illness / Death in Immediate Family [Family medical emergency (surgery, long-term illness) or death of immediate family member (does not include grandparents]Unanticipated Change in Financial Situation [Financial emergency, does not include "did not understand what I was accountable for"or "did not receive expected scholarship"]Visa/Resident Permit Issue [Delay or denial of issuance of visa/residence permit, out of your control]Other

Please submit the applicable documentation

Change in Health	Completed Refund Appeal Medical Supplement Form
Illness/Death in Immediate Family	Letter from attending physician or copy of death certification
Unanticipated Change in Financial Situation	Paperwork documenting bankruptcy, loss of employment, etc.
Visa/Residence Permit Issue	Proof of timely application, process, timeline
Other	Required documents to support your claim

Documentation*

Cancelof
SECTION C: Personal Statement
You must submit a personal statement explaining your reason for appeal. There is no length requirement, but any information you are willing and able to provide will be kept private and used to inform the committee's decision.

Please submit a PDF or Word File
Personal Statement*

Cancelof
SECTION D: Student Certification
I have understood the impact my study abroad program cancellation will have on my current and future registration, GPA, and progress toward graduation, as well as financial aid (if applicable). I have also informed the necessary parties including my academic adviser and the Office of Student Finance (if applicable) about the program cancellation.
Clear
Should be Empty:

DIS Refund Appeal Form

SECTION A: Student Information

SECTION B: Reason for Appeal & Documentation

SECTION C: Personal Statement

SECTION D: Student Certification