Refund Request Form
Finance Office
For Finance office use only
University Canada West
Suite 100-626 West Pender Street
Date Received:
Vancouver, BC V6B 1V9
Phone: 604-915-9607/ 1-877-431-6887
Part I: Student Contact Information
Program of Study: ______________________ Student Number:______________________________
Last Name: ____________________________ First Name:___________________________________
Phone #: _____________________________Email:________________________________________
Current Address:
Part II: Refund Request Requirements
IMPORTANT: Please review Policy 3001 Student Tuition Refunds for complete information on
refund eligibility before completing this form as restrictions apply, including the following:
Domestic Applicants may receive a 100% refund of deposit, less applicable fees, if they cancel/withdraw before
the add/drop deadline for the term.
International Applicants who have received a Conditional or full Letter of Acceptance may ONLY receive a
refund of their deposit, less applicable fees, if they have received an official visa rejection or study permit denial
from IRCC and cancel/withdraw before the add/drop deadline for the term. Official documents must be
provided. Students will be ineligible for a refund if the visa or study permit is denied due to misrepresentation
OR UCW cancels the student’s application due to misrepresentation or falsified documents.
Continuing Students may receive a full tuition refund, less applicable fees, for classes dropped before the
add/drop deadline for the term.
Reason for Refund request: ____________________________________________________________
(International applicants must enclose their official Visa Rejection Letter with this form.)
Part III: Refund Delivery Option
Check one of the following options for receiving your refund:
o Bank wire transfer (please provide clear wire transfer details on page 2 of this form).
o Please mail to address below.
Mailing Address (if different from above):
Refunds will be processed within 30 business days of all required documents being received by the
UCW Finance Office
I understand the information provided above and have reviewed Policy 3001 Student Tuition Refunds.
I understand that the information collected on this form is needed and used by University Canada West for purposes
consistent with activities necessary for the evaluation and issuing of tuition refunds. The University collects, uses,
and discloses your personal information as permitted or required by applicable legislation and regulation. UCW is
owned by Global University Systems that is based in the United Kingdom and the Netherlands. Accordingly, please
be aware that the information collected on this form may be stored and accessed outside of Canada. If you have any
questions, please consult our Privacy Policy https://ucanwest.ca/media/105004/6751-informationprivacysecurity.pdf or
contact our Privacy Officer at 604.915.9607.
________________________________ ______________________________
Student’s Original Signature Date
FO/Forms/Refund Request Page 1 of 2 rev August 2017
Refund Request Form
Finance Office
For Finance office use only
University Canada West
Suite 100-626 West Pender Street
Date Received:
Vancouver, BC V6B 1V9
Phone: 604-915-9607/ 1-877-431-6887
WIRE PAYMENT REQUEST
You are responsible for providing current, accurate information for the processing of your
tuition refund request.
Bank Details
1 Beneficiary bank account #
2 SWIFT (for international transfer)
ABA # (for USA only)
Bank # (for Canada only)
3 Bank Name
4 Bank Street Address
5 City, Province/ State
6 Country
Beneficiary details
1 Beneficiary name
2 Address
3 City, Province/State
4 Country
Intermediary bank details (when applicable)
1 Intermediary bank name
2 Address, city, province, country
3 SWIFT
4 Account #
This template has been completed or reviewed by the beneficiary’s banking institution to confirm that the information
disclosed is complete and accurate, thus ensuring a direct and immediate transfer of funds.
Bank stamp and signature:
FO/Forms/Refund Request Page 2 of 2 rev August 2017
