(See Notes 1 & 2)
SCHOOL___________________________________ PROGRAM______________
STUDENT__________________________________ FILE # ____________________
|
The following should be taken from the official school attendance record:
Divide the hours attended by the total hours in the program to get the applicable pro rata percentage (See Note 1): (______)_Total hours attended (B)_ = (C) __________ Example: 1528 hour barber program; student attended 323 hours. 323 ÷ 1528 = 0.21; pro rata percentage is 21% |
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| Item | Dollar Amount |
|---|---|
| 1. Total tuition charged to the student | 1. $_________________ |
| 2. Total charges for fees for books, supplies, etc. (must be identified in the approved catalog and documented on the ledger) Books__________________ Laboratory Fee___________ Supplies________________ Registration______________ Miscellaneous____________ |
2. $_________________ |
| 3. Total of lines 1 and 2 | 3. $_________________ |
| 4. If registration fee is less than $10.00, enter that amount here If registration fee is more than $10.00, enter $10.00 here |
4. $_________________ |
| 5. Total amount paid by the student and VA | 5. $_________________ |
| 6. Subtract line 4 from line 5 | 6. $_________________ |
| 7. Amount in line 5 that covers books, supplies and miscellaneous consumable items issued to the student and non-returnable | 7. $_________________ |
| 8. Subtract line 7 from line 6 | 8. $_________________ |
| 9. Write the number from C (calculated in the block above) | 9. $_________________ |
| 10. Multiply line 8 times line 9 | 10. $_________________ |
| 11. Add lines 10, 7, and 4 (amount to be retained by the school) (see Note 2) | 11. $_________________ |
| 12. Refund due to student (subtract line 11 from line 5) (See Note 1) | 12. $_________________ |
Refund paid within 40 days after last date of attendance ___ YES ___ NO
CHECK NO. or EFT NOTATION ___________ CHECK/EFT AMOUNT ____________________
Note 1: If the school’s refund policy is more favorable to the student, the school’s policy will be used.
Note 2: This form is optional: The school may charge the student a sum that does not vary more than 10% from the exact pro rata portion of tuition, fees, and other charges that the length of the completed portion of the course bears to its total length.