NSCC U-PASS REFUND/OPT IN REQUEST
May 2021
LAST NAME: FIRST NAME:
STUDENT #: CONTACT EMAIL:
ADDRESS:
POSTAL CODE: TELEPHONE:
PLEASE SELECT ONE OPTION (either refund or opt in)
□ REFUND REQUEST: Please do not submit your U-Pass Refund Request form until you are registered in a program.
This is a mandatory student service for full time students attending one of our three Metro/HRM campuses. Students
must meet the conditions of one of the following refund provisions. Please choose one option and provide necessary
documentation (if required).
□ I am officially withdrawing from NSCC prior to the advertised deadline for my program.
□ I am changing my student status from full time to part time prior to the official add/drop date for the term.
□ I currently hold a valid Access-a-Bus, CNIB, WIH or X-Pass transit pass. (Please include a photocopy of both sides of
your pass with this form)
PLEASE NOTE: If you have already received your U-Pass sticker, your U-Pass sticker must be handed in to the
Business Office before any refund will be issued.
□ OPT IN REQUEST: Please do not submit your U-Pass Opt In Request form until you are registered in a program.
The ability to opt in to the U-Pass program is limited to full time students only.
□ I am studying full time in a program through online synchronous delivery.
□ I am studying full time online through eCampus.
Instructions:
It is the student’s responsibility to ensure that this form is completed and includes ALL required supporting documentation.
Additional information regarding U-Pass refunds and submission deadlines can be found at www.nscc.ca/upass
Completed forms can be submitted to one of the following campus Business Offices (Akerley, IT or Ivany) via email.
Please add the subject line UPASS to your email.
akerley.info@nscc.ca
ivany.info@nscc.ca
ITCampus.info@nscc.ca
Those not successful in receiving a refund or opting in to the program will be contacted via email.
DATE REQUEST RECEIVED: ACTIONED BY (Staff name):
REFUND DECISION (Please indicate): □ GRANTED □ DENIED
U-PASS RECEIVED FROM STUDENT?
□ YES
□ NO □ N/A (not previously issued)
IF DENIED, DATE STUDENT NOTIFIED:
HELPDESK TICKET TO ADD REVERSE FILED: □ YES □ NO
OPT IN DECISION (Please indicate): □ GRANTED
□ DENIED
U-PASS FEE COLLECTED?
□ YES □ NO
HELPDESK TICKET TO ADD FEE FILED: □ YES □ NO
STICKER APPLIED? □ YES □
NO
IF DENIED, DATE STUDENT NOTIFIED:
