Refund Check Cancellation/Stop Payment Form
Please use this form to cancel or stop payment on a refund check issued to you from your NSU student account. To view
refund dates, balances due, and the preferred mailing address on your NSU account, log into SharkLink. You may submit
the completed form to the Office of the University Bursar by mail or fax (see contact details above) or deliver it to the One-
Stop Shops located on the first floors of the Horvitz and Terry Administration Buildings on the main campus.
Section I: Cancellation Authorization. Complete A, B, and C.
A. Student Name _______________________________________ NSU ID: N ___ ___ ___ ___ ___ ___ ___ ___
(Print Name)
B. Please check the one phrase that completes the following statement:
My refund check…. was not received but address is correct was received but later lost or destroyed
was mailed to the wrong address other: ___________________________
C. I authorize NSU to do one of the following:
Cancel the refund check and re-issue to me Check Date_________ Amount $___________ (Go to Section III)
NSU reserves the right to apply cancelled refund check funds to any outstanding balance remaining on a student’s account. A maximum of
$200 of current term federal aid funds may be applied to prior term charges.
Cancel the refund check, pay balance due, Check Date_________ Amount $___________ (Go to Section III)
and then re-issue remaining funds to me
Cancel refund check, pay balance due, and Check Date_________ Amount $___________(Go to Section II & III)
return remaining funds to reduce my loan balance
Cancel the refund check, pay to TEACH Grant Check Date_________ Amount $__________ (Go to Section II & III)
Section II: Tell us how to return the loan or grant funds. Check boxes and write amounts below:
Fall 201___ $___________ [ ] Private [ ] Plus [ ] Unsubsidized [ ] Subsidized [ ] Perkins [ ] TEACH Grant
Winter 201___ $___________ [ ] Private [ ] Plus [ ] Unsubsidized [ ] Subsidized [ ] Perkins [ ] TEACH Grant
Spring 201___ $___________ [ ] Private [ ] Plus [ ] Unsubsidized [ ] Subsidized [ ] Perkins [ ] TEACH Grant
Summer 201___ $___________ [ ] Private [ ] Plus [ ] Unsubsidized [ ] Subsidized [ ] Perkins [ ] TEACH Grant
Total dollar amounts indicated for return and amount paid to account must equal the total of the check attached. For Direct Loans,
cents will be rounded to the next dollar upon return. If multiple loans are checked for the same term, funds will be returned to clear
the balance on loans in the order above from left to right. If both loan and grant return is indicated, loan funds will be returned first.
Section III: Sign, date, and provide contact number and current address.
____________________________________ _________________________ ______ _________________________
*(Student Signature) *(Date Signed) *(Daytime Phone Number)
________________________________________________________________________________________________________________________
*(Current Mailing Address)
*required
PLEASE NOTE:
• Allow 5-7 business days for processing.
• If the check has been cashed, a copy will be mailed to your mailing address on file. Bank records (including check records) are not
available after 7 years.
• NSU checks issued on or after June 29, 2012, are marked void after 90 days. Uncashed refund checks issued before June 29,
2012, that include federal student aid funds will be cancelled and made void after 180 days. Funds will then be returned to the
appropriate federal program.
• Direct Loan funds returned to the lender within 120 days from the day of disbursement (to your NSU account) will have the
origination fees reduced in proportion to the amount returned.
