Form Ps-1040r - Texas Workforce Commission Refund Worksheet - Vocational Programs Page 2

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Calculate tuition and included fees earned by the school for the current portion charged:

Tuition and included fees for current portion charged

(2b from previous page)

(

From previous page)

8. Total of tuition and fees earned from prior (How many?

portions charged

)

Earned fees and supplies for the whole program:

9. Administrative fees earned, but not included in tuition (not to exceed $100.00)

10. Chargeable* books not included in tuition (receipts required):

11. Chargeable* supplies and other fees not included in tuition (receipts required):

+ $

*Must be necessary for portion of program attended & separately stated in enrollment agreement

12. Total earned by school for the whole program

(items 7 + 8 + 9 + 10 + 11) = $

13. Total amount paid towards #12 on behalf of student

(Fees, Tuition, Books, Supplies)

14. Refund due (if #13 is greater than Item #12) =

15. Balance due school (if #13 is less than Item #12)

Documentation:

The following documents must be readily available, preferably attached to this Refund Worksheet in the

Student’s file:

1. Enrollment Agreement

2. Record of Previous Education & Training (PS-010)

3. Complete attendance record

4. Complete progress record w/status changes

5. LOA/make-up requests (if applicable)

6. Ledger

7. Book & supply receipts (if applicable)

8. Proof of consummation of refund

For questions concerning Texas Workforce Commission Career Schools and Colleges Cancellation and

Refund Policy, please consult the form series PS-023; law governing Career Schools and Colleges, Title 3,

Texas Education Code, Section 132.061 and 132.0611; and the Texas Career Schools and Colleges Rules,

Title 40, Texas Administrative Code, Sections 807.261 through 807.264.

___________________________________________________________________________________________________________________________

Completed forms, inquiries, or corrections to the individual information contained in this form shall be sent to the TWC Career Schools and Colleges, 101

East 15th Street, Room 226T, Austin, Texas 78778-0001, (512) 936-3100. Individuals may receive and review information that TWC collects about the

individual by emailing to

open.records@twc.state.tx.us

or writing to TWC Open Records, 101 E. 15th St., Rm. 266, Austin, TX 78778-0001.

___________________________________________________________________________________________________________________________

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PS-1040R

PREVIOUS EDITIONS OF THIS FORM WILL NOT BE USED

REV 05/12