1. SignanddropoffatID Card OfficeinCampusCenterB‐52
2. SignandfaxedtoID Cardat518/442‐8029(pleasecall518/442‐5989to confirmreceipt)
3. ElectronicallysignandemailfromtheaccountownersUAlbanyaddressto idcard@albany.edu
PODIUMACCOUNTREFUNDREQUEST
Completeformandchooseoneofthedeliveryoptionsbelow:
NOTE:formsreceivedfromalternativeemailaddresseswillnotbeprocessed
IfyouareofficiallyleavingtheUniversity,youcanrequestafullPodiumrefunduptosix(6)monthsaftergraduating,
withdrawing,orendingemploymentattheUniversity.Yourrefundissubjecttoa$5processingfee.
IfyouofficiallyleavetheUniversitywithoutrequestingarefundofyourunusedPodiumbalance,youwillbechargedamonthly
inactivityfeeof$20startingwiththeseventh(7
th
)monthofsuccessiveinactivity.Thatfeewillbedeductedfromthevalueof
yourunusedbalancepriortoissuinganyrefund.Theamountofanymonthlyinactivityfeesisnotrefundableinwholeorinpart
andwillnotberestoredtoyouevenifyoulaterrequestarefundofyourremainingbala
nce.Yourrefundissubjecttoa$5
processingfee.
RemainingPodiumbalances
forstudentsoremployeeswhohavebeeninactiveforthree(3)consecutiveyearswillbesubjectto
escheating.
Balancescannotbetransferredtootherpeopleoraccounts(e.g.,MunchMoney).
NAME:_______________________________________ STUDENTID#:___________________________
DATE:_______________________________________ EMAIL:_________________________________
MAILINGADDRESS(checkwillbemailedtothisaddress):
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________________
Bysigningthisdocument,youareattestingthatyouarenolongeractivelyenrolledoremployedwithUniversityatAlbany,and
agreeingtohaveyourcurrentPodiumBalance,lessthe$5.00processingfeedeductedfromyourPodiumAccountandrefunded
bychecktobesenttheaddressprovidedonthisform.Yourcurrentbalancemaybelessnon‐refundableinactivityfeesifithas
been7monthsormoreafteryoulefttheUniversity.Ifyouarefoundtobeanactivestudentoremployee,yourrefundwillnot
beprocessedandyouwillbenotifiedattheemai
laddressabove.
SIGNATURE:_____________________________________________ DATE:______________________
FOROFFICEUSEONLY:
PROCESSEDINCSGOLDINSUNYCardON:____________________BY:__________________________
BALANCEATTIMEOFREQUEST:$___________Z&hE&dZ$5.00FEE$ͺͺͺͺͺͺͺͺͺͺͺͺͺ
RECEIVEDINUASFINANCEDEPARTMENTON:____
_______________
_BY:_______________________
GLCODING:____________________________________________________________________
FINANCEAUTHORIZATION:______________________________ DATE:____________________
PAYMENTINFORMATION:CHECKNO:__________DATE:________________INITIALS:___________
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signature
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