Cancellation Request Form

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					                   CANCELLATION REQUEST FORM Version 2011.1



YUELI ID        Last Name               First Name                       Date of Birth



Phone Number                            Cell Phone Number               Email Address


DOCUMENTATION
I am submitting the following documentation in support of my cancellation and refund request:
 Visa or study permit denial letter              Medical doctor’s note
 YELT score                                      Other

FULL-TIME PROGRAMS
Course           Accommodation                  Academic Program
                                              3110 Jan.10 – Mar.04
                                              3120 Mar.07 – Apr.29
                                              3130 May.09 – Jun.30
                                              3140 Jul.04 – Aug.26
                                              3150 Sep.06 – Oct.28
                                              3160 Oct .31– Dec.21

                                                Pre-MBA Program
                                              3170 Jul.04 – Aug.26
                                              3180 Oct.31 – Dec.21

                                                Destination York Program
                                              3135 Mar.07 – Apr.29
                                              3145 Jul.04 -- Aug.26
                                              3155 Oct.31 – Dec.21

                                                Pre-Graduate Preparation Program
                                              3181 Jan.17 – Aug.26
                                              3189 May 16 – Dec.21
                                              3191 Sep.12 – Apr.27


Please indicate your reasons for canceling the above course(s) and/or accommodation(s):
 Visa denial or other immigration issues         Finances
 Family/personal emergency                       Medical emergency
 Level 6 pass                                    YELT test score
 Unsatisfactory Homestay experience              Decided on another school
                                                   Name of school:
 Other:




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PLEASE INDICATE YOUR PAYMENT METHOD FOR THE COURSE(S) AND ACCOMMODATIONS:

A.        If you paid using a bank transfer from a Canadian bank, certified cheque or money
order, please provide the information requested below:
Bank transfers from a Canadian bank will be refunded with a cheque. Please indicate how you would
like to receive your cheque:

 Mail            Hold for pick up at YUELI (photo identification required)


Last Name                                         First Name


Street Address                                    City


Province/State                                    Postal/Zip Code


Telephone                Cell Phone               Fax               Email

B.      If you paid by credit card or debit card, the refund will be paid to the original card and
cardholder. Please notify us if the card holder’s information has changed. For refund by debit
card, the card holder must be present at the YUELI office for the refund on Wednesdays from 9
am to 12pm. YUELI will notify the card holder at what time to arrive at YUELI for their refund by
debit card.

C.     If you paid from outside Canada or the US, using a wire transfer, please provide the
       information requested below:
Refunds issued by bank transfer will incur an additional administrative charge of $25.


First Name Of Account Holder             Last Name                  Account Holder’s Address


Account Number                                                      Name of Bank


Bank Address                                                        Bank Phone Number


Bank Email/Fax Number                                               Bank SWIFT Number

To be eligible for a refund, this form and any necessary documentation must be received by YUELI
within 30 days of the initial cancellation notification. Incomplete forms (missing contact information,
signature, etc.) will not be processed. Refund processing time is usually 4-6 weeks. If you have not
received a refund in 6 weeks, please contact YUELI for further assistance. A refund cheque must be
picked up within 6 months, otherwise it will be cancelled.

DECLARATION : I have provided a full and accurate account of my situation. I recognize that it is my
responsibility to include all documentation. I understand that missing documentation may result in the
delay or denial of my refund. I have read and understood the “2011 Cancellation & Transfer and
Policy Version 2011.1” document (available at the YUELI office and at
http://www.yueli.yorku.ca/cancellation) for full-time and part-time programs OR the related information
on the application form for the Destination York or Pre-Graduate Program.


Signature                                         Date


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