Form 2773 - Notice To Terminate A Met Educational Benefits Contract - 2007

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Contract Number(s)
Michigan Department of Treasury
2773 (Rev. 11-07)
Notice to Terminate a MET Educational Benefits Contract
Issued under Public Act 316 of 1986.
Use this notice when attending a Michigan independent or out-of-state institution under Full, Limited and Community College contract
(or Michigan public institution if you have a Community College contract) OR to receive a refund. Submit this notice to MET by July 15
before the Academic Year in which the Beneficiary (student), wishes to terminate the Contract. Allow 4-6 weeks for processing.
*Beneficiary Name (Student)
Beneficiary's Social Security Number
Street Address
Daytime Telephone
(
)
City, State, ZIP Code
E-mail Address
Name of Institution Beneficiary Will Attend
Semester and Year Refund will First be Effective (i.e. Fall 2005)
(required info. under all options)
The Beneficiary requests termination of the above referenced contract for the following reason:
_____
a.
Beneficiary will attend a Michigan Independent, Degree-granting College or University. Attach: 1) Acceptance letter
and 2) W-9 form for refund designee (regardless of where you direct refund).
To whom should refund be paid?
____ College (Weighted Average tuition)
____ Refund Designee (Lowest tuition to Person in Item 16 of Contract Signature Page)
____ Initial to Confirm
_____
b.
Beneficiary will attend an Out-of-State Institution of Higher Education. Attach: 1) Acceptance letter and 2) W-9 form
for refund designee (regardless of where you direct refund).
To whom should refund be paid?
____ College (Average tuition for Full Benefits and Lowest tuition for Limited Benefits)
____ Refund Designee (Lowest tuition to Person in Item 16 of Contract Signature Page)
____ Initial to Confirm
_____
c.
Beneficiary has received a full tuition scholarship, is enrolled in a United States Military Academy or has GI Benefits.
Attach: 1) Verification of scholarship that states terms (what costs will be covered per term/semester as well as
number of terms/semesters covered or terms of renewal), and 2) W-9 form for refund designee.
_____
d.
Beneficiary does not plan to attend a Higher Education Institution. Complete the affidavit on the reverse side of this
form stating that you, the Beneficiary, do not plan to attend a Higher Education Institution. The affidavit must be
notarized. Attach: W-9 form for refund designee (Person in Item 16 of Contract Signature Page).
_____
e.
Beneficiary is Disabled or has died. Attach: 1) a sworn or attested statement of the Beneficiary's Disability. If the
Beneficiary has died, the person with legal authority to act on behalf of the Beneficiary should submit a certificate of
death and sign the form below in place of the Beneficiary's signature, and 2) W-9 form for refund designee (regardless
of where you direct refund).
_____
f.
Beneficiary has a Full or Limited Benefits contract and has or will attend a Community College and intends to
terminate the Contract for a refund payable to the Community College. Attach W-9 form for refund designee.
_____
g.
Military. Attach: 1) Copy of enlistment contract and 2) W-9 form for refund designee.
_____
h.
Beneficiary has a Community College contract and will attend a Michigan public 4-year institution. Attach: 1)
Acceptance letter and 2) W-9 form for refund designee (regardless of where you direct refund).
To whom should refund be paid?
____ College (Weighted Average tuition)
____ Refund Designee (Lowest tuition to Person in Item 16 of Contract Signature Page)
If you are unsure of the appropriate reason for termination, call MET at (800)-638-4543.
*Signature of Beneficiary (Student)
Date
*Beneficiary must be at least 18 years of age or have a high school diploma. If you are not 18 years of age, attach a copy of
your high school diploma.
MAIL TO: Michigan Education Trust, P.O. Box 30198, Lansing, MI 48909 or Fax: (517) 373-6967.

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