Online Refund Request Form

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	Please complete this form to request a refund for a General Adult Education class. Refunds will be submitted via check and will take up to two weeks for processing. Refunds are automatic if the class selected has been cancelled by the Adult Education Department. NO REFUNDS will be given after the start of class.

	Name:*

	E-Mail:*

Address:*

Street Address
City
State
Zip

	Phone Number:* xxx-xxx-xxxx

	Please indicate the class title of the course in which you are requesting a refund.*