NO-SHOW DISPUTE FORM

Appointments must be cancelled at least two hours prior to your scheduled appointment
time. Failure to do so results in a fee charged to your student account. If you believe this
fee was charged to you in error or have a valid reason why you weren’t able to make it to
your appointment, please complete this form and upload it to your MyMcKinley portal.

Name:___________________________
Grant Roche
UIN:_______________________
663509427

Phone #__________________________
224-440-2516
Date of Birth:________________
05-18-2005

University Email Address:_______________________________________

grroche2@illinois.edu

Date of Appointment:____________________________________
10/31/2023

Time of Appointment:____________________________________
2:30PM

Please state the reason you were not able to keep your appointment:
I was confused, since I filled out a form under the "Schedule an Online Appointment" Button

I was under the impression that my appointment would be online, and since it was requested

for me to put my phone number in, I assumed I would get called or something along those lines.

I was not feeling well enough to cross campus to get there in person so I was trying to make an online
appointment.

INSTRUCTIONS TO UPLOAD FORM TO PORTAL

1. Log into the MyMcKinley Portal

2. Click on the Upload icon
3. Select “No Show Dispute Form” from dropdown box
4. Select “File” to browse
5. Select your document
6. Click Upload

Your dispute will be reviewed and you will receive a secure message regarding our
decision in 7 to 10 days. If approved, your Student Account will be credited at that time.