Part A – Student Information
● Credit card payments will be refunded to the credit card account. A refund check will be issued if we are unable to
refund to the credit card account. Cash, check, or e-check payments will be refunded via check.
● Flywire payments will be refunded to the original account.
● Submission of this form does not guarantee eligibility for a refund.
● PLEASE ALLOW 3-5 WEEKS OF PROCESSING.
Received Date: ___________________ Refund Amount: ____________________
Received by: ___________________ Approved by: ____________________
Remarks: ___________________ Approved Date: ____________________
Last updated 2/2/2018
STUDENT REFUND REQUEST FORM
To be completed by all students requesting a refund.
All relevant fields MUST be completed or this form will not be accepted.
□ Health Insurance Waived
□ Withdraw from University
□ Other - please specify:
Part C – Original Payment Method
□ Check, Cash, Money order or E-Check
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