Refund Request Form
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1REFUND REQUEST FORM
IMPORTANT:
PLEASE DO NOT SUBMIT THIS FORM UNLESS YOU HAVE A CREDIT ON YOUR STUDENT ACCOUNT.
REFUND POLICY:
*
In order to receive a refund for a dropped class; the student must have dropped the class before the refund deadline.
The only exceptions are: cancellation of a class by the college, withdrawal from school due to military orders, or classes
dropped due to failure to meet the course prerequisites.
*
Refunds are given to the student only.
Student ID #: ___________________________________________________________________
Name
___________________________________________________________________
Address
___________________________________________________________________
City
________________________________ State _____ Zip Code ____________
Phone Number __________________________________________________________
Survey question: Did you drop class (es) due to campus parking limitations (check one)?
Yes
No
NOTE: REFUND MUST BE PROCESSED BY CREDIT CARD IF PAYMENT WAS MADE BY CREDIT CARD.
We do Not process refunds to AMEX cards. Please provide Visa, MasterCard, or Discover credit card.
Expiration Date:
My payment was by credit card. My credit card # is:
Month
Year
My payment was by cash or check. Mail my refund check to the above mailing address.
RETURN FORM TO:
Student Payment Office SSC 208
Refund Processing Time:
28000 Marguerite Parkway
Mission Viejo, CA 92692
* Credit Card refunds may take up to 2 weeks from receipt of this form.
(949) 582-4870
* Check refunds may take up to 30 days from receipt of this form.
Fax (949) 582-4571
STUDENT PAYMENT OFFICE USE ONLY
DISTRICT OFFICE USE ONLY
FEE CATEGORY
AMOUNT
Refund Amount
Health Fee
$ ______________
$ ______________
Enrollment Fee
Date Paid
Material Fee
$ ______________
Date of Check
ASB Card
$ ______________
$ ______________
Capital Outlay Fee
Verified By:
Check Number
$ ______________
Non-Resident Fee
Other
$ ______________
Date:
Processed By:
Total:
$ ______________
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Parent category: Business