Office of International Education Refund Request Form

This form should only be used to request a refund of the enrollment deposit.

Last Name:*

First Name:*

myWSU ID:

Email Address:*

Semester of Admission (Example: Spring 2021):*

Date of Enrollment Deposit Payment:*

What is the Flywire Payment ID?

Name of the Payer:

Relationship of Payer:

Reason for Refund Request:*

Questions (if any):

Have you set up eRefunds in your WSU Student Account Suite?*

Yes

No

Not Sure

I understand the following:

• This form may only be completed by the student who applied for admission.

• By requesting this refund, your admission and I-20 will be automatically canceled. Once canceled, your I-20 cannot be used to enter the U.S.

• Before issuing a refund, we will look in SEVIS, a U.S. federal database, to confirm that your I-20 was not used to enter the U.S. If your Wichita State University I-20 was used to enter the U.S., you will not be eligible for a refund of the enrollment deposit.

• Any refund will be returned to the bank account from which it was originally sent.

• Payments that were made more than two years ago could have been sent to the State of Kansas as unclaimed property. In that case, students will need to contact the State of Kansas to request a refund.

• Refunds may take up to 60 days to be processed.

DISCLAIMER: By typing your name below, you are signing this form electronically. You agree that your electronic signature is the legal equivalent to your official handwritten signature.

Signature of Student (Type Your Name):*

Signature Date:*