OHIO NORTHERN UNIVERSITY
OFFICE OF THE CONTROLLER
REQUEST TO RETAIN CREDIT ON ACCOUNT
Date: ___________________________
Student’s Name: ______________________________________
Student’s ID #: _______________________________________
College Level:
Term:
Undergraduate
Summer
Academic Year:
2015-16
Law
Fall Semester
2016-17
Graduate
Spring Semester
2017-18
2018-19
I understand that my credit will remain on my account for the term specified only. I understand
that if I wish to have this credit refunded, I understand that I will need to revoke this authorization
form by filling out the section below.
______________________________________________________
Signature
Date
**REVOKE AUTHORIZATION**
By signing below, I revoke the authorization to retain the credit balance on my account and request
that it be refunded.
______________________________________________________
Signature
Date
Rev. 3/9/15
Arts & Sciences • Business • Engineering • Pharmacy • Law Since 1871
525 SOUTH MAIN STREET • ADA, OH 45810 • (419) 772-2010 • FAX: (419) 772-2778 • www.onu.edu • controller@onu.edu