Student Refund Request Form
________ Please send my refund check to my home address.
________ Please send my refund check to the following address (complete only if different from the home address):
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Street
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City, State, Zip
________ Please send my refund check to my host institution. I understand that this payment will be applied to my non-tuition expenses, and that any amount not covered by my refund is my responsibility. I have attached a copy of the bill from my host institution, so that F&M can make payment as requested. Please send the check to the host institution at the following address:
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Name of School
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Street Address of School
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City, State, Zip of School
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Student Name (please print), F&M ID Number
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Signature
