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Withdrawal, Refund and Insurance Opt-out Request Form

General Information

I am a student of:(Required)
Hidden
MM slash DD slash YYYY
As per our policies, the date that you submit this request impacts your refund elibilty. Please review the relevant policy here: https://continue.yorku.ca/support/policies/ before submitting a withdrawal request.
Name(Required)
Email(Required)

Type of Request

I would like to request a(Required)

Overpayment Refund Request

Please fill in the refund request details below. Please confirm that your student portal is showing an overpayment before submitting a request.

Residence/Meal Plan or Optional Fees Refund

I am requesting a refund for(Required)
Please provide details on what you are requesting a refund for.

Opt Out and/or Refund Request for Insurance

Please note: All students are required to have health insurance that covers the length of their course.
Type of Insurance Request(Required)
Check all that apply.

Opt Out of Insurance

Please note: The deadline to opt out of insurance is the end of week one (1) of your program. If you do not cancel your insurance with us by that deadline, insurance will be ordered for you, and you will be required to pay the fee. If you have your own personal insurance that will last the length of your program, you may request to cancel insurance with us.
Please upload proof that you already have insurance. Proof of insurance must clearly indicate the student’s name, the policy number, the start and end date of the policy and must be valid for the entire length of the program.
Drop files here or
Max. file size: 8 MB, Max. files: 4.

    Request a Refund for Insurance

    Please confirm that you have already paid for insurance before requesting a refund by reviewing your payments in the Student Portal. See below for instructions.

    Withdrawal

    Would you like to withdraw from a program or a course?(Required)

    Program Withdrawal Information

    Have you previously deferred ?(Required)
    As per Policy, students who have previously deferred may not be eligible for a refund. Please review the relevant policy here: https://continue.yorku.ca/support/policies/.
    Reason for Program Withdrawal(Required)
    Please upload a copy of the Visa Denial letter and any other supporting documents.
    Drop files here or
    Max. file size: 8 MB, Max. files: 8.
      Please upload a copy of any supporting documents.
      Drop files here or
      Max. file size: 8 MB, Max. files: 8.

        Course Withdrawal Information

        Please list all of the courses you wish to withdraw from. Please include the full course code (e.g. CSBA1020).
        Reason for Course Withdrawal(Required)

        Please upload a copy of any supporting documents.
        Drop files here or
        Max. file size: 8 MB, Max. files: 8.

          Other Comments and Refund Request

          Please provide additional details to explain your request.
          Would you like to apply for a refund?(Required)
          Please review policy to see refund eligibility criteria: Please review the relevant policy here: https://continue.yorku.ca/support/policies/.

          Payment Information

          Please review your payments and check your balance before filling in the refund request details below. Follow the steps below to do so.

          • Log in to the Student Portal here: https://my.continue.yorku.ca/portal/logon.do?method=load
          • On the left sidebar, click on "My Account History". Review all transactions/payments.
          • On the left sidebar, click on "My Invoices". Review any outstanding invoices (money that is still owing).
          My Invoices Example:
          My Account History Example:
          Would you like your refund allocated to your York University student account?(Required)
          This is NOT your School of Continuing Studies student account. Only choose this option if you are also a degree-program student with York University.
          Approval-York University Account Refund(Required)
          How did you pay your tuition? (Select all that apply)(Required)
          Check all that apply if you paid via multiple payment methods. Please note: refunds are sent only to the original method of payment to the original payor.
          Please provide details on how you paid your tuition.
          Please note, if you are eligible for a refund:

          Credit Card refunds may require 1-2 weeks for processing.

          Bank Wire refunds may require 7-8 weeks for processing. The account holder name, bank name and bank account number entered into this form must match EXACTLY with the proof of payment that you upload.

          Bank Wire & Bank Transfer Information

          Did you send your payment from multiple different bank accounts? (Different account numbers, different account holder name, etc.)(Required)

          Bank Wire Information #1

          Please enter the details of the first bank account that you paid from. This must match our records of your payment.
          Account Holder #1: Name(Required)
          Account Holder #1: Address(Required)
          Please enter the name of your banking institution.
          Bank #1: Address(Required)
          This must match the account number that you paid from.
          Upload proof of payment. Documents need to clearly identify the payor name and the amount paid.

          The account holder name, bank name and bank account number entered into this form must match EXACTLY with the proof of payment that you upload.
          Drop files here or
          Max. file size: 8 MB, Max. files: 4.

            Bank Wire Information #2

            Please enter the details of the second bank account that you paid from. This must match our records of your payment.
            Account Holder #2: Name(Required)
            Account Holder #2: Address(Required)
            Please enter the name of your banking institution.
            Bank #2: Address(Required)
            This must match the account number that you paid from.
            Upload proof of payment. Documents need to clearly identify the payor name and the amount paid.

            The account holder name, bank name and bank account number entered into this form must match EXACTLY with the proof of payment that you upload.
            Drop files here or
            Max. file size: 8 MB, Max. files: 4.

              Bank Wire Information #3

              Please enter the details of the third bank account that you paid from. This must match our records of your payment.
              Account Holder #3: Name(Required)
              Account Holder #3: Address(Required)
              Please enter the name of your banking institution.
              Bank #3: Address(Required)
              This must match the account number that you paid from.
              Upload proof of payment. Documents need to clearly identify the payor name and the amount paid.

              The account holder name, bank name and bank account number entered into this form must match EXACTLY with the proof of payment that you upload.
              Drop files here or
              Max. file size: 8 MB, Max. files: 4.

                Bank Wire & Bank Transfer Authorization

                Bank Wire & Bank Transfer Authorization(Required)

                Declaration and Final Comments

                Please enter any other comments you have on your request here.
                Declaration - Withdrawal(Required)
                Declaration - Overpayment(Required)
                Declaration - General(Required)
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