ࡱ> WYV Ibjbj11 JJSS " " |||||8\$\*Y#Y#Y#)))))))$T+.f*|Y#!Y#Y#Y#*||*g(g(g(Y#|p|)g(Y#)g(g(g(ndN#^g(),*0\*g(l.K$xl.g(l.|g(`Y#Y#g(Y#Y#Y#Y#Y#**%Y#Y#Y#\*Y#Y#Y#Y#l.Y#Y#Y#Y#Y#Y#Y#Y#Y#" B:  REFUND APPEAL FORM (Adjustment of Tuition and Fees) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TO BE COMPLETED BY STUDENT:  Refund Requested by: Name of Student___________________________ Student I.D. #_________________  Address: Street Address City State Zip code  Contact Phone #  Supporting Documentation Attached? Yes No Read and carefully follow the instructions on this form to ensure your request may receive fair consideration. Lack of specific information and failure to supply accurate dates will adversely impact response to your request.  Semester/Year Date of dropCourse/SectionCredit Hours Date of dropCourse/SectionCredit Hours Provide a carefully detailed chronological explanation of why you feel you are justified in requesting a refund. Attach additional documentation, such as letters from physicians, etc., to support your explanation. You must provide dates in your explanation. TYPE OR PRINT: (Please attach a letter to continue your explanation if needed) ***STUDENT MUST COMPLETE THE SECOND PAGE OF THIS FORM*** Form 1143/001 (3/13) Page 1 of 2 Explain in careful detail the payment arrangements you made for that semester. Your statement should particularly include: (1) an explanation as to how any financial aid arrangements relate to your payment and (2) what is the current status of your student account for which you are seeking a refund. TYPE OR PRINT: (Please attach a letter to continue your explanation if needed) ______________________________ ____________________ Students Signature Date ** STUDENT MUST SUBMIT ORIGINAL FORM TO FEE COLLECTIONS CENTER 1st flr Elkins Hall** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - RECEIVED BY FEE COLLECTIONS: _________________________________ ___________________ Signature of Fee Collections Staff Date - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - RECOMMENDATION OF REFUND COMMITTEE: Refund Approved Refund Disapproved % of Refund COMMENTS:  _____________________________________________ ___________ Signature, Refund Committee Chair Date Form 1143/001 (3/13) Page 2 of 2     PAGE3 45    1 4 A B S T ŵ|pf\f\R\fHRfhAB*CJphhB*CJphhnFB*CJphhbSB*CJphhbS6B*CJph4jhhnFCJOJQJU^JaJmHnHuhJ/hZ456B*ph *hIJohbS56B*ph *hIJohJ/56B*phh1hJ/B*CJphhr3h\15CJaJhZ45CJaJhr3h7D5CJaJh\15CJaJhZ45 T V a $l!&`#$/Ifgd|1$gd*CJaJ& *hAh*56B*CJaJphh wh56B*CJphha_B*CJphhAB*CJphhB*CJphhAOJQJ^Jh|56B*CJphhhnF56B*CJph     Qkd$$Ifl^F8 b!  t 6`l!08 6    44 layt|$l!&`#$/Ifgd|  7 D E F | }  ; G H I J ˽qfffqqWIjha_UmHnHuha_ha_B*CJaJphh|hKCJaJhAha_56CJaJhAhK56CJaJhAh*CJaJhB*CJphh(h wB*CJ aJ phh_h_< h(h wh(h w5CJaJ     cQQQ$l!&`#$/Ifgd|kd$$IflF8 b!  t 6`l!08 6    44 layt| cQQQ$l!&`#$/Ifgd|kdZ$$IflyF8 b!  t 6`l!08 6    44 layt|   * 7 c^LLL$&`#$/Ifgd wgd_kd$$IflF8 b!  t 6`l!08 6    44 layt|7 8 9 : ; cQQQ$&`#$/Ifgd wkd$$Ifl^FY   t 6`0m 6    44 layt w; < = > ? cQQQ$&`#$/Ifgd wkda$$IflFY   t 6`0m 6    44 layt w? @ A B C cQQQ$&`#$/Ifgd wkd$$IflyFY   t 6`0m 6    44 layt wC D E F H I c]T]]OOF $1$a$gda_gda_ $1$a$gd1$gda_kd$$IflFY   t 6`0m 6    44 layt wJ X  W Z } ˿znbUG<hAha_CJaJhAha_5>*CJaJhAhAB*CJphhA6B*CJphhA6B*CJphhAB*CJphhAhAB*CJ aJ phhAhA56CJaJ *hAh|56CJaJ *hAhA56CJaJ *hA56CJaJha_5CJaJha_ha_B*CJphha_ha_5h\15mHnHuha_5mHnHu 89gda_1$gda_$P1$^P`a$gdA $1$a$gdAgdZ4 $1$a$gda_} 89:HIѺvre[TG *hAh|56CJ hAh|ha_B*CJphha_56B*CJphha_ha_B*CJphha_ha_5h\15mHnHuh\1h\15mHnHuha_5mHnHujha_UmHnHuha_ha_B*CJaJphhACJaJhAha_CJaJhl+56CJaJhAha_56CJaJhA56CJaJ   1$^ gda_ 1$^gda_gdZ4 $1$a$gda_gda_&-/16ACDE67IYftf]R]IB>Bh hAh|hAh|CJhAh|CJ aJ hAh|CJhAh|56CJaJh56>*CJaJhAh|56>*CJaJhAh|B*CJaJphhAh|56CJhA56CJ *hh|56CJ *hh *hh56CJH* *h56CJ *hS*56CJ *h\156CJ *hA56CJE7f%'bcmqruxy{|}1$gd\1  1$^gd|   1$^ gd|gd|1$gd| $1$a$gd|fg"%&')*9;MPRVabxj_jUH;hIJoh|5B*phh(h|5B*phhEEB*CJphh(h|B*phh(h|56B*ph)jh(h|B*UmHnHphu*jhEE5B*CJUmHnHphuh(h|B*CJphh(h|56B*CJph#hAh|56B*CJaJph&hAh|56>*B*CJaJphhAh|B*CJaJphhAB*CJphbcklmnuwx{|}񻱥~viZiMi@hA56B*CJphhJ56B*CJphhAhAB*CJaJphh|56B*CJphh|B*phh-hcB*CJaJphhcB*CJaJphh|B*CJaJphhAB*CJaJphh|B*CJph'jhcB*CJUmHnHphuhIJoh|56B*CJph"hIJoh|56>*B*CJphhIJoh|5B*CJph  !*$%& #$1$a$ 1$]^d1$ $1$a$gda_ $1$a$gdA H1$gd|   !"&'()+,-./0123456789:;<=>?¼–|hYOh OJQJ^Jh?]]* $d%d&d'dNOPQgda_&$d%d&d'dNOPQgd&$d%d&d'dNOPQgd*&$d%d&d'dNOPQgd w ?@ABCDEFGHI{ $1$a$gda_* $d%d&d'dNOPQgdc&$d%d&d'dNOPQgd|&$d%d&d'dNOPQgdEE ?@ABCDEFGHI hZ4ha_hzh*B*CJ OJQJphjR@"j Body Text Indent 2 `p01$^p`0 B*CJph424 Header  !4 B4 Footer  !ZS@RZ Body Text Indent 3 p1$^p B*CJphzcz  Table Grid7:V05$7$8$9DH$PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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