Pellissippi State Hardin Valley Campus
Exterior of Goins Building
Pellissippi State aerial view

Forms

Payment Agreement

This form is used to make payment arrangements for debts owed to the college for prior terms.

To file this form electronically you will need to verify your identity by electronically signing this document.
Please select the appropriate link below:

You will receive an email notification when your documentation has been submitted.

To manually (non-electronically) sign and submit this document:

  • Download, complete, and print the Adobe PDF version - Once completed and signed
    • you must take it to the Cashier's Office at any campus
    • or mail to Pellissippi State Community College - Cashier's Office - PO Box 22990 - Knoxville, TN  37933-0990
  • Please note:  Submitting this form without making a payment will not prevent your account from being sent to an outside collection agency.
  • If you have any questions regarding this process please contact Brenda Johnson 865-694-6613 or bjjohnson@pstcc.edu

Student Refund Appeal

This form is for appealing a refund policy decision please attach/submit documentation supporting your appeal

To file this form electronically you will need to verify your identity by electronically signing this document.
Please select the appropriate link below:

You will receive an email notification when your documentation has been submitted.

To manually (non-electronically) sign and submit this document:

  • Download, complete, and print the Adobe PDF version - Once completed and signed
    • you must take it to the Cashier's Office at any campus
    • or mail to Pellissippi State Community College - Cashier's Office - PO Box 22990 - Knoxville, TN  37933-0990
  • If you have any questions regarding this process please contact the Cashier's Office 865-694-6605 or businessoffice@pstcc.edu.