PARKING PERMIT REFUND REQUEST
Student Name: ___________________________________________ T#: ___________________ Term: __________
(Last) (First) (MI)
S
tudent Email: _____________________________________________ Permit #: _____________________________
Reason for Refund Request:
W
ithdraw from University
Graduated
Other: _______________________________________
Student Signature: _________________________________________ Date: ____________
TERMS FOR PERMIT REFUND:
• Refunds are permitted for any student who is no longer enrolled in classes and who meets all other terms for this
process.
• A Refund Request Form must be submitted with the returned permit (product) in good physical condition.
• A Full refund is available if all paperwork is completed and turned before the final academic purge for the Fall
semester full-term courses. After this deadline the refund amount is reduced to 50% of the cost of the permit.
• No refunds will be accepted after the final purge is completed for the Spring semester full-term.
• All refunds are applied to the student account and will follow the University refund policy.
• Refund amounts are based on the date of which all documents are received by the office – If a deadline lands
when the University is closed or on a weekend, refund requests and permit will be due by the end of business
before the deadline.
• Refunds are not permitted for summer permits.
OFFICE USE ONLY:
Refund Amount: __________ Approved Denied Reason: ________________________
Approved by: _____________________________ Date: ________________
You must submit this form with
your permit to:
Parking & Transportation Services
Campus Box 5167
Cookeville, TN 38505
Ro
aden University Center 122
click to sign
signature
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