Franklin & Marshall College Franklin & Marshall College

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):

____________________________________________________________  Street  

______________________________________________________________   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

______________________________________________________________  Signature