Transcription Fee Appeal Form

Home
ABOUT
Transcription Fee Appeal Form

Transcription Fee Appeal Form

If you feel there are significant circumstances affecting your financial situation, you may submit an appeal request for your Student Health Services immunization record transcription fee. This is for transcription for newly admitted student immunization records. Appeals must be submitted within 30 days from the date of service. Allow at least 5 business days after submission for review of your appeal request. Student Health Services may request additional information regarding your appeal.

"*" indicates required fields

Student Name*

First Last

Student G#*

Mason Email*

Responses will only be sent to a Mason email address

Reason for Appeal*

Please explain your reasons for your appeal of the Immunization Transcription fee.

Phone

This field is for validation purposes and should be left unchanged.