Refund Request Form - Cashier's Office

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's Office web page or our information board found near the Cashier's Office Window (Room 1211).

All fields are required.

Your Information

First Name:
Last Name:
Street Address:	Street Address line 2:
City:
State/Province:
Zip/Postal Code:
Country:
Telephone Number:	(Include area code.)
Ohlone Student ID Number:	(Do not use your Social Security 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.

Your privacy is important to us. Your personal information will not be sold or shared with unaffiliated third parties except as necessary to maintain and process client accounts or when the law requires it.

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