Get International Center Memorandum - California State Polytechnic ... - Csupomona

This guide provides a comprehensive walkthrough for filling out the International Student Health Insurance Refund Form at California State Polytechnic University, Pomona. Follow these clear steps to navigate the process efficiently.

Follow the steps to complete your refund request online.

1. Click ‘Get Form’ button to access the refund form and open it for editing.
2. Enter your name in the designated field labeled ‘Student’s Name’ clearly.
3. Provide your Bronco ID number in the corresponding field.
4. Indicate the quarter for which you last paid for insurance by selecting the appropriate option and entering the year.
5. State the final quarter of your attendance at Cal Poly, along with the year.
6. Select the reason for your refund by checking the corresponding box, such as graduation or change of status.
7. If someone else will receive your refund, fill in their name and address under the section designated for the refund recipient.
8. Sign the form in the space provided for your signature.
9. Date the form in the field next to your signature.
10. Review all entries for accuracy, then save changes, download, print, or share the completed form as needed.

Complete your International Student Health Insurance Refund Form online today.