Form Tr-0383 - Payment Request (Page 2 of 2) in pdf

SECTION B - PAYMENTS TO PURCHASER OR BENEFICIARY

Please complete this section if you would like BEST to make a payment directly to the Purchaser or Beneficiary

as an advance payment or reimbursement for qualified higher educational expenses. Please allow 10-12

business days for receipt of payment.

Payee:

Purchaser

Beneficiary

Amount Requested: $ ____________________

Address: _______________________________________________________________________________

(Street)

(City)

(State)

(Zip Code)

Withdrawal Purpose: ___________________________

Semester: ______________________________

SECTION C - SCHOLARSHIP REFUND PAYMENTS PAYABLE TO REFUND RECIPIENT

Please complete this section and attached proof of scholarship award for current or prior terms. You may

collect the scholarship proceeds in advance of the current term, but the refund recipient will incur Federal

income tax liability. Payment will be sent to the refund recipient listed on the original BEST application. The

refund recipient must sign the form to receive the scholarship refund.

Address: _______________________________________________________________________________

(Street)

(City)

(State)

(Zip Code)

Amount Requested: $ __________________________

Term(s): _______________________________

SECTION D - AUTHORIZATION

I hereby certify the information listed above is true and correct. I further certify that I intend to use the

withdrawal amount as indicated above and that the dollar amount or number of units is what is needed to pay

tuition, other qualified higher education expenses required for enrollment or as a refund for a scholarship.

I understand that scholarship refunds for the current and prior terms will be calculated using the current

weighted average tuition (WAT) value. I understand that I must be enrolled at the institution at least half-

time in order to quality for room and board benefits. I authorize release of information regarding my BEST

prepaid tuition account to the institution named above. By my signature below, I authorize BEST to calculate

the number of tuition units needed to pay the amount indicated to the institution and/or the recipient of the

payment. For Tennessee public institutions, I authorize BEST to send the amount billed by the institution not

to exceed the amount noted on this form.

Student’s Signature: ________________________________________

Date: _____________________

Parent/Guardian’s Signature: _________________________________

Date: _____________________

(required if student is under age 18)

Purchaser’s Signature: ______________________________________

Date: _____________________

(required if Purchaser is the refund recipient)

TR-0383 (Rev. 4/15)

- 2 -

RDA-2516

Form Tr-0383 - Payment Request Page 2

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