Fillable Refund Request To be completed and signed by (New Mexico Institute of Mining & Technology)

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Refund Request To be completed and signed by (New Mexico Institute of Mining & Technology)

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Refund Request
To be completed and signed by the student.
Date
Name Banner ID
Please issue a refund check for the credit balance on my account. By signing below, I agree that any
changes in financial aid and/or charges for room, meal plan or any miscellaneous charges posted to my
account after issuance of my refund check are my responsibility and MUST be paid.
NOTE: Refund forms must be turned in to Student Account’s Office, Joseph Fidel Center, Second
floor by 10:00 a.m. on Tuesday to receive a refund check the following Friday after 2:00 p.m. (unless
otherwise posted).
Refund Amount $
Comments
Student’s Signature Date
Disbursement Instructions
Student In Town Checks will be dispersed at the cashier’s window.
Student Out of Town Provide self-addressed stamped envelope to mail off-campus.
Street
City State Zip Country
BUSINESS OFFICE USE ONLY
Students Acct’s Signature Date
Notes
Revised 12/02/09
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Refund Request To be completed and signed by (New Mexico Institute of Mining & Technology)

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Completed 23 July 2020

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