Request for Refund
Instructions for Completion:
- Name to whom the refund check is to be made payable.
- Social security number, student ID number, or taxpayer ID number.
- Address, including city, state, and zip code.
- Reason for the refund.
- Account number to which the receipt was originally deposited.
- Source code which was originally used to make the deposit.
- Number of the receipt which was written when the funds were received.
- University unit head or other individual authorized to request the refund.