The refund calculation form is a calculation sheet used to determine refunds owed to students who cease instruction, whether through withdrawal or termination, prior to the completion of the program.
SCHOOL NAME
SCHOOL LOCATION
REFUND CALCULATION FORM
(terms)
STUDENT NAME: ______________________________________________
Social Security No. _________________________ D.O.B. ___/___/___
Program ___________________________________ Hours ________
Start Date ___/___/___ Last Date of Physical Attendance ___/___/___
Scheduled Graduation Date ___/___/___ Hours Offered to Student _______
Schedule: _____ hours each week for _____ weeks
This schedule divides the program into _____ terms. The student’s last date of physical attendance occurred during week number _____ of term number _____.
Total tuition for the program $__________ Tuition per Term $________
Percentage of last term’s tuition retained _______%
Student Tuition Liability for the Last Term Attended: $______________
Student Tuition Liability for Previous Terms Completed: $______________
Student Liability for Textbooks Accepted: $______________
Non-Refundable Registration Fee: + $______________
Total Student Liability: $______________
Total Student Payments Including Grant/Loan Payments $______________
Refund Due if Payments Exceed Liability: $______________
Date of Refund ___/___/___ Check No. __________
SCHOOL NAME
SCHOOL LOCATION
REFUND CALCULATION FORM
(quarters)
STUDENT NAME ____________________________________________________________
Social Security No. __________________________ D.O.B. ___/___/___
Program _______________________________________ Hours ____________
Start Date ___/___/___ Last Date of Physical Attendance ___/___/___
Scheduled Graduation Date ___/___/___ Hours Offered to Student __________
Schedule: _____ hours each week for _____ weeks
This schedule divides the program into _____ quarters. The student’s last date of physical
attendance occurred during week number _____ of quarter number ______.
Total tuition for the program $__________ Tuition per Quarter $__________
Percentage of last quarter’s tuition retained __________%
Student Tuition Liability for the Last Quarter Attended : $_______________
Student Tuition Liability for Previous Quarters Completed: $_______________
Student Liability for Textbooks Accepted: $_______________
Non-Refundable Registration Fee: + $_______________
Total Student Liability: $_______________
Total Student Payments Including Grant/Loan Payments $_______________
Refund Due if Payments Exceed Liability $_______________
Date of Refund ___/___/___ Check No. __________
SCHOOL NAME
SCHOOL LOCATION
REFUND CALCULATION FORM
(mini-program)
STUDENT NAME ___________________________________________________
Social Security No. ______________________________ D.O.B. ___/___/___
Program _____________________________________________ Hours _______
Start Date ___/___/___ Last Date of Physical Attendance ___/___/___
Scheduled Graduation Date ___/___/___ Hours Offered to Student _____
Schedule: _____ hours each week for _____ weeks
The student’s last date of physical attendance occurred after _____% of the program.
Total tuition for the program $__________
Percentage of tuition retained ___________%
Student Tuition Liability: $_______________
Student Liability for Textbooks Accepted: $_______________
Non-Refundable Registration Fee: + $_______________
Total Student Liability: $_______________
Total Student Payments: $_______________
Refund Due if Payments Exceed Liability: $_______________
Date of Refund ___/___/___ Check No. _____