WORKFORCE DEVELOPMENTNON-CREDIT COURSE REFUND REQUEST FORM

WORKFORCE DEVELOPMENT
NON-CREDIT COURSE REFUND REQUEST FORM

PROVIDE A CAREFULLY DETAILED EXPLANATION for your request for a refund regarding a non-credit course. You can attach additional pages for your explanation if needed. You must attach supporting documentation, such as letters from physicians, employers, etc., as it pertains to the nature of your refund request. Lack of specific information and failure to supply documentation supporting your reason/explanation will adversely impact the response to your request.

This form may be submitted via email to the designated Workforce Development department
offering the training for which a refund is being requested.

Name of Student Student I.D. #

Address:
Street Address City State Zip Code

Phone # Email

Date of Non-Credit Course Withdrawal	Non-Credit Course Title/Course ID/Section ID	Start Date of Non-Credit Course

TYPE OR PRINT the reason/explanation for refund request (You may use additional pages if needed.) You must attach supporting documentation.

______________________________ ____________________
Student’s Signature Date

FOR OFFICE USE ONLY

Received by (initials): ________
□ Walk-In □ Email □ Fax □ Mail
Date Received: _____________

Date Reviewed: _____________ □ Refund Approved □ Refund Denied
Reviewer’s Signature: ________________________________________
Comments (if applicable):

Form WFD-001/01 (6/21)