________ 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):
______________________________________________________________ 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:
______________________________________________________________ Name of School
______________________________________________________________ Street Address of School
______________________________________________________________ City, State, Zip of School
_____________________________________________________________ Student Name (please print), F&M ID Number