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REFUND APPLICATION FORM
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Contact Number
This contact number will be used if any questions - Please enter full number with area / country code.
Your answer
ID Number / Application Number
*
Your answer
Date of Enrollment
*
If never attended - Please put the date of acceptance to WUSOM
MM
/
DD
/
YYYY
Last Date of Attendance
*
If never attended - Pleas enter the date of acceptance to WUSOM
MM
/
DD
/
YYYY
Refund Amount Requested
*
Your answer
Fee Payments till date
*
Please enter total amount paid till date.
Your answer
Semesters attended at WUSOM
*
select all the semesters attended at WUSOM by checking the boxes below
NONE
PREMED-1
PREMED-2
PREMED-3
MD-1
MD-2
MD-3
MD-4
MD-5
MD-6
MD-7
MD-8
MD-9
MD-10
Other:
Required
Refund Method
Please select on which form you would like to get a refund
Bank Draft
Wire Transfer
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