REQUEST FOR REFUND FORM
ENROLLMENT FEE REFUND POLICY
1.) No refunds will be given to students who withdraw from classes after the No-Grade-of- Record (NGR) deadline.
For refund deadline see the Academic Calender at our website, Class Schedule booklet or at Admissions and Records Office.
2.) A $10 processing fee will be subtracted from each enrollment fee refund (with the exception of classes cancelled by the College.)
3.) Refund checks will be sent by mail approximately 6- 8 weeks after the NGR deadline. Please note: If the address provided below differs from the information listed
in our system, your signature on this form authorizes Las Positas College to change your address.
4.) NON-RESIDENT AND INTERNATIONAL TUITION REFUND POLICY * Prior to the first day of instruction - 90%
* During the first week of instruction - 75%
* After the first week of instruction - NO REFUND
REASON FOR WITHDRAWAL: (Please check)
Become employed/unemployed
Personal/family concerns
Financial need
Class cancelled by college (waived processing fee)
Schedule conflict
Other (list):
I understand the conditions of the policy stated above.
COMMENTS:
DO NOT WRITE BELOW THIS LINE ADMISSIONS OFFICE USE ONLY
ENROLLMENT FEE SUBJECT TO REFUND
$
NON-RESIDENT TUITION SUBJECT TO REFUND
% $
LESS PROCESSING FEE
($10.00)
OTHER
AMOUNT OF REFUND
$
Prepared by:
Approved by:
Date:
BUSINESS OFFICE USE ONLY
Total amount refunded: $ By:
Dean of Enrollment Services
DATE:
Please mail this form to: Fax to: Scan and email:
Las Positas College Attn: Refund Attn: Refund
Attn: Refund (925) 606-6437 lpc-admissions@laspositascollege.edu
3000 Campus Hill Drive Livermore, CA 94551
Refund form SR/js 4/14
Office of Admissions & Records
3000 Campus Hill Drive
Livermore, CA 94551
(925) 424-1500 • Fax (925) 606-6437
Email: lpc-admissions@laspositascollege.edu
SEMESTER:
Please print legibly. Refund check will be mailed to the address noted.
SUMMER
FALL
SPRING
YEAR:
W
STUDENT ID NUMBER (REQUIRED): NAME (LAST NAME, FIRST, MI):
CURRENT ADDRESS (NUMBER, STREET, CITY, STATE & ZIP CODE): PHONE NUMBER:
Initial:
Student's signature:
click to sign
signature
click to edit
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