INTERNATIONAL STUDENT WITHDRAWAL/REFUND FORM
The withdrawal application must be received by St. Lawrence College
within 10 days of the beginning of the semester.
All funds will be returned to the person, or financial institution which originally paid the fees to St.
Lawrence College. All funds will be returned using the same financial instrument by which they were
received by the College (e.g. via wire transfer, money order, credit card refund). It is the student’s
responsibility to provide the correct banking information. Refunds will be processed after all required
documents are received. Refund processing can take up to 90 days.
Student Information
First Name: Last Name:
Student ID No.: Email:
Program Name: Semester:
Request for
Withdrawal
Refund
Withdrawal + Refund
Reason (s) and required Supporting Documents
Visa refusal
Attach the visa refusal letter.
Transfer to another school
Attach the letter of acceptance of another school. $2,350 non-refundable deposit will be charged.
Failing Marks
Overpayment
Medical
Attach certificate from doctor
Other (please specify e.g., changing/deferring program)
Bank Information
Please note that exchange rate differences and local bank charges are the responsibility of the
student.
Information on the beneficiary:
Beneficiary Name:
Beneficiary Address:
Student’s relationship to the beneficiary:
Information on the beneficiary’s bank:
Beneficiary’s bank:
Swift code:
Bank identifier:
IFSC Code/Bank Branch Code:
Bank address:
Destination country:
Beneficiary account number:
Bank Currency:
Please fill out below information ONLY if the bank information you provided above is not under
your name. (For example, if you want to refund the money to your father or mother, you need to fill
out below information)
My name is _________________________, SLC ID # ___________________ . And I authorize
________________________________, to receive a refund of my tuition fee on behalf of me.
(the beneficiary)
_________________________________, paid for my tuition fees on behalf of me.
(the beneficiary)
His/her mailing address is:
If you require further information, please contact me at .
I have read & fully understand the terms and conditions of the St. Lawrence College withdraw/refund
policy. I understand the refund process can take up to 90 days.
______________________________________ _______________________________
Signature: Date (MM/DD/YY)
(must be signed by the student only)
