Early Start Enrollment & Refund Form
(please print clearly in black or blue ink)
Questions about this form? Call 559.278.0333
or visit www.fresnostate.edu/cge
Use this form to:
-ADD, DROP, or SWITCH your Early Start courses. Complete Sections 1 and 2 and sign the form.
-Request a REFUND for your Early Start course (including refunds for exemptions). Complete Sections 1 and 3 and sign the form.
View Early Start enrollment and refund policies: www.fresnostate.edu/studentaffairs/outreach/esp/cost.html
Submit this form to:
Continuing and Global Education Office
Kremen Education Building; Room ED 130
Submit by fax: 559.278.0395
Submit by mail: 5005 N Maple Ave M/S ED76; Fresno, CA 93740-8025
SECTION 1: STUDENT INFORMATION
LAST NAME
PHONE NUMBER
FIRST NAME
DATE OF BIRTH
FRESNO STATE ID
EMAIL ADDRESS
SECTION 2: ADD/DROP/SWITCH COURSES
Please indicate courses you wish to add or drop. To switch courses, write the old course in “Drop” and the new course in “Add.”
NOTE: You can also use the MyFresnoState portal to add, drop, or switch your courses prior to the first class meeting.
ADD COURSES:
DROP COURSES:
1
1
COURSE (e.g. ESE 1)
NUMBER (e.g. 50402)
COURSE
NUMBER
2
COURSE
NUMBER
COURSE
NUMBER
2
SECTION 3: REFUNDS
Please indicate courses you would like to have refunded and the reason for the request. If you have been deemed exempt from a
course, write “EXEMPT” as the reason for the request. If approved for a refund, you will be automatically dropped from the course.
1
COURSE (e.g. ESE 1)
NUMBER (e.g. 50402)
REASON FOR REFUND REQUEST
COURSE
NUMBER
REASON FOR REFUND REQUEST
2
REVIEW AND SIGN
By signing this document, I affirm that all of the information provided is complete and accurate to the best of my knowledge and
that I understand the Early Start enrollment and refund policies detailed on the Fresno State website (see link at top of page).
STUDENT SIGNATURE
DATE
Office Use Only (Continuing and Global Education)
ES Coord.
Tuition Rfnd
Crs Fee Rfnd
Registrar
OS Coord.
No Rfnd
Units Dropped
I certify that $
Amnt Approved
Initial
Office Use Only (Accounting Services)
Refund student’s acct ($)
Refund processed by
Initial
RECEIVED BY (CGE STAFF PRINT NAME)
was collected/sponsored
Date
Date
Total Rfnd($)
Approved by
Refund Paid on Check #
Date
Approved by (initial)
Initial
Date
Initial
Date
Date
Date
Date
Last Updated: 5/10/16 DH