Refund Request Form
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1San Joaquin Delta College
Refund Request
Refund Policy: Classes must be dropped prior to submitting this form. All forms must be received
by the refund deadline date. Please refer to the Registration Calendar for specific dates.
If you drop or withdraw from San Joaquin Delta College, you are not necessarily entitled to a refund.
Refunds are granted only for classes dropped by published deadlines. For full-term, late-starting or short-
term classes, check the Schedule of Classes or your registration confirmation receipt for refund
information. Parking permit refunds will be granted only if ALL classes are dropped on or before these
same deadlines. Refunds are subject to a $10.00 processing fee. (This form may be used up to 2 terms.)
DELTA ID: ___________________________
LAST NAME: ___________________________
FIRST NAME: _____________________________
ADDRESS: __________________________________________________________________________
CITY: ________________ STATE: _____ ZIP CODE: __________ PHONE #: ___________________
SIGNATURE: ____________________________________________
DATE: _______________
*NOTE: Address above must be the same as reported address on your student record. By signing this
form you are authorizing the Admissions & Records Office to update your records IF address reported on
this form does not match your student record.
AMOUNT
TYPE
TERM/YEAR
$
Non-Resident Tuition
F
SPR
SU
_______
$
Enrollment Fee
F
SPR
SU
_______
$
Parking Fee (Permit # ___________)
F
SPR
SU
_______
$
Other
F
SPR
SU
_______
AMOUNT
TYPE
TERM/YEAR
$
Non-Resident Tuition
F
SPR
SU
_______
$
Enrollment Fee
F
SPR
SU
_______
$
Parking Fee (Permit # ___________)
F
SPR
SU
_______
$
Other
F
SPR
SU
_______
Accounting Use
Admissions & Records Use
Fee Type:
Non-Resident Tuition/Enrollment
Total Amount
Waive Processing Fee
Processed By
Parking
Other
Processing
$
YES
NO
Total: $ ______________________
Rev 04/13
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Parent category: Business