PETITION FOR REFUND

PLEASE PRINT CLEARLY

A student who has paid enrollment fees and has dropped all or some of his/her classes within 10% of class meetings may request a refund by submitting a completed refund petition.

Students are eligible for a refund of fees if:

1)Course withdrawal occurs by the drop deadline (refer to current class schedule); and

2)A Refund Petition Form is submitted by the deadline (prior to the last day of the semester in which the refund applies)

STUDENTS ELIGIBLE FOR BOGW AND TUITION ASSISTANCE:　 If you paid for your classes and later qualify for a fee waiver or tuition assistance, you must apply for a refund by the deadline.

CANCELLED CLASSES:　If your class is cancelled, a refund will automatically be sent to you.

Account balances MAY NOT BE CARRIED FORWARD.　 If you are eligible for a refund, please be sure you request one before the end of the semester since an overpayment cannot be applied to a future semester.

During the Fall and Spring semesters it may take from 4-6 weeks for you to receive your refund check in the mail.　If you apply for a refund for SUMMER CLASSES, please be aware that they will not be processed until after July 1 and then may take 4-6 weeks after that date.　 Credit card adjustments and cash refunds are not available.　

Name:		*(For E-mail Address)*
NAME: Last		First MI:
Email:		*(Enter your exact email address)*
Postal Address:	Number & Street	Telephone Number:
	City, State, ZIP

SEMESTER OF REFUND: Summer Fall Spring Year:

Last four of SSN:

I, the above-named petitioner, do hereby apply for a refund of resident tuition (state mandated fee) in accordance with provisions of Ed Code and CCC Board of Governors regulations. I fully understand that Barstow College shall refund, upon request, any enrollment fee paid by me in excess of that computed pursuant to Sec 58501 for program changes made during the first two weeks of instruction (Or 10% of course meetings for other than full-term courses).

Please indicate reason for refund: Class Canceled BOGW TA Student Drop Other

The following statement must remain in the box below, or the refund cannot be issued.

Date Signature of Petitioner

TO BE COMPLETED BY RECORDS OFFICE

Refund Amount: $

Term and Year:

Date:

Authorized Signature:

TO BE COMPLETED BY BUSINESS OFFICE

Check Number: Dated: Mailed:

IN LIEU OF PURCHASE ORDER

Authorized Signature:

TO BE COMPLETED BY RECORDS OFFICE
Refund Amount: $
Term and Year:

Date:
Authorized Signature:

TO BE COMPLETED BY BUSINESS OFFICE
Check Number:	Dated:	Mailed:
IN LIEU OF PURCHASE ORDER
Authorized Signature: