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 six (6) months after graduating, withdrawing, or ending employment at the University. Your refund is subject to a $5 processing fee.
- If you officially leave the University without requesting a refund of your unused Podium balance, you will be charged a monthly inactivity fee of $20 starting with the seventh (7th) month of successive inactivity. That fee will be deducted from the value of your unused balance prior to issuing any refund. The amount of any monthly inactivity fees is not refundable in whole or in part and will not be restored to you even if you later request a refund of your remaining balance. Your refund is subject to a $5 processing fee.
- Remaining Podium balances for students or employees who have been inactive for three (3) consecutive years will be subject to escheating.
- Balances cannot be transferred to other people or accounts (e.g., Munch Money).
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. Your current balance may be less non‐refundable inactivity fees if it has been 7 months or more after you left the University. 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*

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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

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Podium & F/S Dining Plan Refund Request

For Office Use Only:

Payment Information: