* Indicates a required field

* Location
ARC  CRC  FLC  SCC  SRPSTC

* Term
Spring  Summer  Fall

Student Information
*First Name:    Middle Initial: 
*Last Name:    *Student ID #: W 
Email Address: 

Reason for Refund Request
Dropped Class(es)   Overpaid Fees  
California College Promise Grant (formerly Board of Governors or BOG Fee Waiver)
Other (If Other, please explain)  

Refund requested for(check all that apply)
 Enrollment Fees (incl. Res., Non-Res. & International) (see Refund Policy above)  UTP Fee
Did you pick up your Student Access sticker? (See Refund Policy above) Yes   No

Prior to submission, verify

  1. you have dropped, by the required deadline, the courses for which you are requesting a refund,
  2. we have your correct address on file and
  3. your account shows a credit balance due.