University of Rochester
EMERGENCY INFORMATIONCALENDARDIRECTORYA TO Z INDEXCONTACTGIVINGTEXT ONLY

GOG Refund Request Form


Mail the completed form via intracampus mail to:

Salvatore Priore
Hutchison Hall B11
Chemistry Department
Rochester, NY 14627


This Form must be received by by the registration deadline for each semester.
Click here for a print-friendly version.

* Note: If you do not have an Employee ID#, please contact Donna Derks at
dderks@mail.rochester.edu. There maybe an issue with your refund.



Name:

Student ID:

Department:

Year and status (e.g. 2nd year, full time):

E-mail address:

Please summarize the reasons for your request as specifically as possible:







What would you like to see the Graduate Organizing Group do differently? Is there anything that would make you reconsider your refund request?







I, by signing below, agree not to participate in any GOG-sponsored events nor intentionally benefit from any services by GOG during the effective duration of this refund.

Signature:

Date:


Last modified: Sunday, 26-Apr-2009 01:20:45 EDT