Fillable Class Refund Form2015

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Class Refund Form2015

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IHCC CLASS REFUND FORM
This form is to be lled out and turned in after the course has been successfully
completed. Tuition must be paid before a refund can be generated. This benet
is limited to one course per term.
Today’s Date:
Employee Name:
Soc. Sec/Employee #:
Course Name:
Course Number:
Course Dates:
(start & end dates)
Amount of Refund:
tuition only: total if non-credit / half if credit or retiree
Human Resources Date
Business Ofce Date
Charge to: 10-9-8521-01-59400 Credit
10-9-8521-01-59410 Non-Credit
10-9-8521-01-59430 Retiree
3/15CNT 05
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Class Refund Form2015

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Completed 8 May 2020

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