Admissions Forms | Germanna Community College

Form Instructions

Please follow the listed steps below to complete and submit the available forms.

Complete the requested form information, date and type your full name as your signature and click 'Email Form to Admissions' button at the bottom of the form.
Note: Required field titles are in red.

If a required field or formatted field is formatted incorrectly or missing, please correct and click 'Email Form to Admissions' again.

Contact Information

First Name

Middle

Last Name

Preferred Phone *Enter as xxx-xxx-xxxx

GCC Student ID 7 Digit Student ID Required

Current Term

Current Year

Exception to Refund Appeal

Note: Students must officially withdraw from a course before their appeal will be processed. They must have no grade other than a "W".

Please list the course(s) and or changes you wish to appeal.

Subject Course
Please check all that apply:
Are you receiving GI Bill Benefits?
Yes No

Are you receiving Grant Financial Aid?
Yes No

Are you receiving Direct Loans?
Yes No
Are you in the Nursing Partnership Program?
Yes No

If Yes and the request is approved , an updated transcript may be sent to UMW.
Please indicate the criteria on which you wish. SUPPORTING DOCUMENTATION IS REQUIRED.

Extended period of physical or mental illness

Extended period of physical or mental illness of immediate family member

Death of immediate family member (must send certified copy of death certificate)

Involuntary job transfers outside of the Germanna service area

Error in academic advising

Late notification of denial to specific degree program

Institution errors/delay in process

Administrative difficulties with internships, placements or practicums

Military Deployment Orders/Mobilization
Date Student Signature Date Required
All requests must be supported with a letter explaining the extenuating circumstances and documenation to support the request. Requests without this documentation will not be approved.
I certify that the information provided in my appeal is accurate, truthful, and is in accordance with college policy and procedures.
Type your signature Typed Signature is Required