Housing And Residence Life - Housing Deposit Refund Form

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Housing and Residence Life
Housing Deposit Refund Form
THIS FORM DOES NOT SERVE AS A RELEASE FROM YOUR HOUSING AGREEMENT
PLEASE PRINT LEGIBLY
NAME______________________________________________________ DATE ______/______/________
(Last)
(First)
(MI)
RAM ID NUMBER___________________________ PHONE NUMBER (
)_________-___________
FIRST YEAR ON CAMPUS:__________ LAST SEMESTER & YEAR ON CAMPUS________________
SEM
YEAR
HOME ADDRESSS_________________________________________________________________________
STREET
CITY
STATE
ZIP
MOST RECENT RESIDENCE HALL ASSIGNMENT___________________________________________
(PLEASE INCLUDE APT #)
NO LONGER RESIDING ON CAMPUS AS A RESULT OF {CHECK ONE OF THE FOLLOWING}:
_______Graduation
_______Transferring to another institution, military, etc.
_______No housing available on campus
_______Moved off campus and never claimed deposit
_______Prefer to reside off campus (completed appeal process)
_______Other, please explain____________________________________________________________
_____________________________________________________________________________________
STUDENT SIGNATURE_____________________________________________DATE_______________
------------------------------------------------------------------------------------------------------------------------------------
(OFFICE USE ONLY)
APPROVED  YES
 NO
_____________________________________DATE_______________
HOUSING OFFICIAL SIGNATURE
Amount to be refunded: $200________
$0____________
If approved, a copy of this form is to be forwarded to the Office of Financial Operations by a Housing and Residence
Life Official. Upon receipt of the form, the Office of Financial Operations will verify that the student has paid a
Housing deposit of $200. Once payment is verified, the refund process will begin. Student should receive their
refund within 45 day after Financial Operations verifies payment. Any outstanding debts to the University will be
deducted BEFORE the refund is issued. If debts exceed the refund, the student will not receive a refund.
NOTE: Financial Operations will not process refunds between June 1 and July 15 due to performing fiscal
year - end closing.
REFUNDS WILL BE PLACED ON THE HIGHER ONE CARD FOR STUDENTS THAT PAID
AFTER 6/30/2005**
EXCEPTION: STUDENTS WHO NEVER ATTENDED ASU WILL RECEIVE A
PAPER CHECK FROM ALBANY STATE UNIVERSITY.
Revised 3/1/2016

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