Fill - Free fillable Fair Refund Request (California State University Channel Islands) PDF form

Student Business Services

Sage Hall

One University Drive Refund Request for Tuition and Fees

Camarillo, CA 93012

Phone: (805) 437-8810

Semester ________________ Year ___________

Filing Requirements:

a) You are “not enrolled” or have officially withdrawn from the University prior to the first day of

the semester.

Instructions:

1. Submit completed form to the Student Business Services Office in person or mail.

2. Students should review the refund policy and guidelines located at the bottom of this page. For

more information regarding tuition refunds, visit the Student Business Services website

Part 1: STUDENT INFORMATION

Student ID: ___________________ Name: __________________________________________

Phone Number: ___________________________ Email: _____________________________

Part II: REGISTRATION/ENROLLMENT INFORMATION

Residency Status: __ CA __ Out-of-State __ International

Financial Aid Recipient: __ Yes __ No

Part III: REFUND INFORMATION

Refund Type Request: ____________________ If not listed, please specify: ____________________

For withdrawal, please provide the “official” withdrawal date: ___________

Refund Option: Select one option only

Address ______________________________________

__ Mail Check: Provide your mailing address: City ________________ State ____ Zip Code ________

__ Direct Deposit: If you are currently a direct deposit participant, your refund will automatically be

deposited to your bank account. If not, you must sign up for direct deposit through your myCI account.

Instructions can be found at: http://www.csuci.edu/sbs/

Part IV: STUDENT SIGNATURE

My signature certifies the accuracy of the above information, and that I have read and understand the

refund requirements and guidelines provided on this form.

Signature: ______________________________________ Date: _______________

Other (please specify)

Student Business Services

Sage Hall

One University Drive Refund Request for Tuition and Fees

Camarillo, CA 93012

Phone: (805) 437-8810

Refund

Official Withdrawal

prior to the 1

Day of

the semester including

students who paid but

did not register for any

classes

Official Withdrawal on or after the 1

day

of school but before the sixty percent

(60%) point in the academic period

Official Withdrawal

after the sixty percent

(60%) point in the

academic period

Policy

-Students will be entitled

to a full refund of tuition

and fees and nonresident

tuition only if they cancel

registration or drop all

courses prior to the first

day of the semester for an

academic term less any

applicable administrative

and un-refundable local

fees.

-The pro-rated refund is determined on the

basis of the date of the student’s withdrawal

and the length of the academic period. The

length of the academic period is calculated

from the first day of the semester through the

final exam day of the period and excludes any

breaks of five (5) days or more.

-A student who officially

withdraws from the

University after the sixty

percent (60%) point in the

academic period, fails to

drop courses, or fails to

officially withdraw by the

end of the campus drop

period shall not be entitled

to any refund of tuition and

fees.

Calculation

Refund Amount = Total

Tuition & Fees Paid – Non-

refundable fees

Refund Rate =

(# of days in the semester - # of days enrolled)

# of days in semester

Refund Amount =

(Refund rate * Total amount of Tuition and

Fees paid) – Non-refundable fees

No refund of tuition and

fees.

Refund

Unit Load Reduction before the sixty percent (60%) point in

the academic period

Unit Load Reduction after the

sixty percent (60%) point in

the academic period

Policy

-A student who reduces their unit load from full-time enrollment

(greater than 6.1 units) to part-time enrollment (6.0 units or less)

before the sixty percent (60%) point in the academic period will

receive a pro-rated refund based on the date of the student’s

withdrawal and the length of the academic period.

-A student who reduces their unit

load after the sixty percent (60%)

point in the academic period shall

not be entitled to any refund of

tuition and fees.

Calculation

Refund Rate =

(# of days in the semester - # of days enrolled)

# of days in semester

Refund amount = Refund rate * Difference between full-time and

part-time tuition

No refund of tuition and fees.

Late Request for Refund: Title V of the CA Code of Regulations provides for late application of refunds only in the

case of death or disability, or if a University rule prevents you from continuing. You must submit a Refund Request

form and a Petition for Waiver of Financial Regulations to the Student Business Services Office in Sage Hall.

Financial Aid Recipient: Refunds are subject to the Return of Title IV Regulations.

Visit http://www.csuci.edu/financialaid/02_01_Application_Process.htm

for additional information.

Debts Owed to the University: Refunds will be applied to any outstanding obligation(s) due to the University.

Standard Processing Time: 2-3 weeks from receipt of completed refund request form

• Official withdrawals: Automatic Refunds process 2-3 weeks from “official” withdrawal date

• Unofficial Withdrawals: 2-3 weeks from 60% point in the academic period

• “Emergency” Refunds: Requests will be reviewed and processed within 5-7 business days

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Fillable Fair Refund Request (California State University Channel Islands)

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