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California State University, Long BeachCalifornia State University, Long Beach

Application For Refund Of Fees

Fields with * are required.

APPLICANT INFORMATION
Note: The university’s policy on refunds is that all payments which were not originally paid by credit card will be refunded via eRefund. Please check your student account to make sure you have a valid bank account set up to receive your refund. You can sign up for eRefund at http://my.csulb.edu.

I hereby request a refund of fees as indicated below, less any amounts not refundable by State and University regulations.

*THE REFUND REQUEST IS FOR





If Refund Request is for Tuition and Mandatory Fees, or Application Fees, the Term and Year are required.

Parking Permit Number (Attach Parking Permit)

*REASON FOR REQUESTING A REFUND




Your refund will be processed within four weeks after receipt of the request. All refunds are subject to a $10.00 refund processing fee.

Student Signature

Date

Received by (Print Name)

Date



Please mail form to Student Account Services BH-155, 1250 Bellflower Blvd, Long Beach, CA 90840, fax to (562) 985-8282, or submit at the Cashier's Office BH-148.




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If you have any problems completing this form, please contact fmsupport@csulb.edu.