General Information
Student First Name
*
Please enter your First Name
Student Last Name
*
Please enter your Last Name
Middle Initial
Please enter your Middle Initial
Parent or Student
*
Parent
Student
If a parent is completing this form, enter name:
Enter parent name if a parent is completing this form.
Email Address
*
Please enter your Email Address
Extension/Phone
*
Enter the Phone number or extension where you may be contacted
Student ID
*
Please enter your Student ID
Semester
Spring 2021
Fall 2020
Summer 2020
Fall 2019
Enter semester that you wish to request a refund for
Program
*
Undergraduate
Graduate
Please select your program
Request for Refund
Make paper check payable to:
*
Please enter your name
Address
*
Please enter your address
Phone Number
*
Enter the phone number for the above address Enter refund amount
Choose from the following two refund amount options.
*
I request to have the total credit balance of my tuition account refunded.
I request to have a portion of the credit balance of my account refunded.
Choose your refund option
If option 2 is selected, please enter amount here:
Enter refund amount
After you submit this form, please scroll to the top of the page for a confirmation message.
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