restitution wksht by 62I0JCj


									                                                    Claim Worksheet

Student Name:                                                       School Name:

Name of Program or Course Studied:

Tuition for Full Program or Course:
 Please attach enrollment agreement, program description, copy of transcript, and price list, if available. Failure
                     to provide a copy of your enrollment agreement may impact your ability
                                        to obtain a refund of your tuition.
Date (start of
course                                                                      Payment
or payment       Name of course/              Completed? Cost per           made to      Type of payment
made)            program of study             (yes/no)         course ($) school        (cash, credit, loan)

            3/3/2003                                                               $10,000      loan
            3/5/2003 Computer programming           yes             $5,000
           6/12/2003 Web design                     no              $5,000
           1/10/2004                                                                            loan discharge $5,000
                       Total claim: $10,000 (payment) - $5,000 (course completed) - $5,000 (discharge) = $0

                                        Please attach additional sheets if necessary.

    Total Claim =
                          = (Total payments) - (cost of classes completed) - (loan discharges) - (loan credits)

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