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Student Billing Statement
Refund Request Form
Use this form to request a refund to be issued to you. The request will remain active from the time submitted through the end of the academic year. A new request must be submitted each year. All refund checks will be mailed while the office is closed to the Public as per COVID-19 protocols.
Student ID
Student Name:
Request Refund?

Hold Refund in Office or Mail?

Here is the billing address we have on file for you, which is where your refund check will be mailed. If this has changed, please update your address below.
Billing Address 1:
Billing Address 2:
Billing City:
Billing State:
Billing Zip:
If your billing address has changed, enter your new billing address below. If no changes are needed, please skip this step.
NEW Billing Address 1:
NEW Billing Address 2:
NEW Billing City:
NEW Billing State:
NEW Billing Zip: