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

Per NC GS 115D-90, 2A SBCCC 400.12, the TASA Catalog, and the TASA Enrollment Agreement, Section 3. The published payment schedule is $200.00 application fee, $2,000.00 (50% tuition) at signing, and $2,000.00 (remaining 50% tuition) 14 calendar days before class. Refunds are calculated from the last date of attendance and processed within 30 calendar days.

Total Tuition Paid	$__________
Application Fee Paid	$200.00 (included in any refund required before the first day of class; later treatment follows applicable North Carolina law and the signed Enrollment Agreement)
Total Program Charges Paid	$__________
Percentage of Program Completed	__________%
Refund Rate (per schedule below)	__________%
Refund Amount Due to Student	$__________

Refund Schedule

When	Refund Rate
Withdrawal before the first day of class	100% of all tuition, fees, and other program charges paid, including the $200 application fee
Withdrawal after class begins and on or before 25% of the 120-clock-hour program	At least 75% of paid tuition and charges eligible for refund under applicable North Carolina law and the signed Enrollment Agreement
Withdrawal after 25% of the program	Calculated according to the signed Enrollment Agreement, catalog, and applicable North Carolina law
School-initiated cancellation	100% of all tuition, fees, and other program charges paid, including the $200 application fee

All refunds processed within 30 days of the withdrawal notification date.

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.
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 for a minimum of five (5) years.
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 chris@tasaedge.com or joy@tasaedge.com.