Podium & F/S Dining Plan Refund Request

Podium & F/S Dining Plan Refund Request
- If you are officially leaving the University, you can request a full Podium or F/S Dining Plan refund up to three (3) years after graduating, withdrawing or ending employment at the University.
- Your refund is subject to a $5 processing fee and a check will be mailed to your home address after processing.
- Balances cannot be transferred to other people or accounts (e.g., Munch Money).
- After three years of inactivity, your funds will be subject to New York State escheating regulations. If we are unable to reach you at that time, the remaining balance will be turned over to the New York State Comptroller. If that balance is over $20, you can request it through the Unclaimed Funds process.
Name*

First NameLast Name
Student ID#*
Date*

MonthDayYear
Date
Email*
example@example.com
Mailing Address (check will be mailed to this address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By signing this document, you are attesting that you are no longer actively enrolled or employed with University at Albany and agreeing to have your current balance, less the $5.00 processing fee, deducted from your account and refunded by check to be sent the address provided on this form.

If you are found to be an active student or employee, your refund will not be processed and you will be notified at the email address above.
Signature*

Clear
Date*

MonthDayYear
Date
By clicking the “Submit” button, I consent to be contacted via email.
For Office Use Only:
Processed in CSGold in SUNYCard on: Date by: Name .
Balance at the time of Request:
$5.00 Fee
Received in UAS Finance Department on: Date by: Name.
GL Coding:
Finance Authorization
Date

MonthDayYear
Date
Payment Information:
Check No:
Date

MonthDayYear
Date
Initials

Clear
Should be Empty:

Podium & F/S Dining Plan Refund Request

For Office Use Only:

Payment Information: