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Refund Request Form - Cashier / Student Receivable

Instructions (please read before completing this form):

You must complete all fields in this form.
Your address must match the address in our system or the refund cannot be processed. If it does not match, please submit a change of address with Admissions and Records before submitting this form to the Cashier’s Office.
Under "Request Refund Type" please check the appropriate box. Note: We are required to credit the credit card used in the original transaction unless the transaction is over 365 days. If it is over 365 days, you will be sent a check.
Your refund will be processed based on the refund schedule found on our Cashier web page or our information board found near the Cashier Window (Room 1211).

All fields are required.

Your Information:

First Name:
Last Name:
Street Address:
City:
State:
Zip/Postal Code:
Country:
Phone:
Student ID Number:
Email address:

Request Refund Type:

I have a credit balance. I paid by Cash or Check. I will receive a refund by check.

I have a credit balance. I paid by Credit Card. Please credit the appropriate card.

I have a credit balance. I paid by a mix of Credit Card and Cash/Check. Please credit the appropriate card for the credit card payments, and send me a refund by check for the cash/check payments.

Checkbox (required for submission): I understand that if the information provided in this form is inaccurate or incomplete my refund date will be delayed.

Cashier / Student Receivable Department

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Refund Request Form - Cashier / Student Receivable

Cashier / Student Receivable Department

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