TASA School and Student Forms

Student Withdrawal Form

NC Proprietary School • TASA-FORM-WTH-001

Student Name

Student ID

Phone Number

Program

Major Appliance Repair Technician — 3-Week Intensive

Session Start Date

Withdrawal Details

Date of Last Attendance

Effective Date of Withdrawal

Program Week at Withdrawal

☐ Week 1 ☐ Week 2 ☐ Week 3

Days Attended (of 15)

Reason for Withdrawal

Type of Withdrawal

☐ Voluntary ☐ Involuntary (dismissed by school) ☐ School-initiated

Refund Calculation

Use the student’s documented last date of attendance and the signed Enrollment Agreement. Apply the minimum statutory rule and any more generous school policy.

Total Program Cost	$__________
Total Tuition and Fees Paid	$__________
Permitted Nonrefundable Fees	$__________ · Description: ____________________
Clock Hours Scheduled / Completed	__________ / __________
Percentage of Enrollment Period Completed	__________%
Refund Rate Applied	__________%
Less Amount Earned by School	$__________
Refund Amount Due to Student	$__________

Minimum Refund Schedule

When	Minimum result
Before the first day of class	100% refund of all tuition and fees paid.
On or before completing 25% of the enrollment period	At least 75% refund of tuition paid, excluding only permitted, clearly disclosed nonrefundable fees.
After 25% of the enrollment period	Calculate under the applicable North Carolina and federal requirements and the signed agreement.
School-initiated cancellation	100% refund of all tuition and fees paid.

Refund will be issued in the same manner as payment when practicable, or by another documented method, within the time required by law and no later than 30 days after the effective cancellation or withdrawal date unless a different federal requirement applies. Refund issued by: __________ on: __________ · Method/reference: ____________________

Student Record Status

Hours Completed	__________ of 120
Attendance Rate	__________%
Assessments Completed
Certificate Eligible	☐ Yes ☐ No
Transcript Issued	☐ Yes ☐ No

Student Acknowledgment

By signing below, I acknowledge that:

I am voluntarily withdrawing from the program (or acknowledge the school-initiated withdrawal).
I understand the refund policy as stated in my Enrollment Agreement and the calculation above.
I have received or will receive a copy of my academic transcript and attendance record.
I understand that my student records will be maintained by TASA in accordance with applicable North Carolina requirements and the school’s records-retention plan.
I have returned all school property, including tools, materials, and access credentials.

Student Signature

Date

School Representative Signature

Date

Student receives a signed copy. TASA retains the original. If student-initiated, student may withdraw by email to info@tasaacademy.com.