This form is good for one refund issued
Student Name:
System ID:
(available in SelfServ/MyProfile/Account Information)
Please make a selection for numbers 1 and 2 below.
1) Amount of Refund:
All Available Funds
OR Refund $
(mark with a “X” to get all available funds) (Provide amount you want refunded to you)
2) Select an Option:
Mail to my address on file _____
OR I will Pick Up
Student Signature
: Date:
If a parent borrowed through the PLUS Loan Program the section below must be completed.
If a PLUS Loan (PARENT LOAN) has been credited to the student account (check student SelfServ if unsure)
all refunds will be issued to the Parent Borrower unless the first option below is completed. If your account
reflects the PLUS loan and this section is not completed, your refund will be delayed until the section below has
been completed.
Select an Option:
Make Check payable to student
Allow my student to pick up the check in my name
Mail to Parent Borrower at the address below:
City, St, Zip:
Parent Borrower Name
(Please Print Clearly) _____________________________________________
Parent Borrower Signature
Fax to: 334-833-4235 (confirm receipt via email at
Mail to: Student Account Manager
Huntingdon College
1500 East Fairview Avenue
Montgomery, AL 36106
Office Use Only:
Date Rcvd. In Office:
Student Acct Mgr Approval: ________________
Received By: Comptroller Approval: ________________