To be completed and signed by the student.
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
Refund Amount $
Student’s Signature Date
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.
City State Zip Country
BUSINESS OFFICE USE ONLY
Students Acct’s Signature Date