Application Fee Reimbursement Form

First Name*

Last Name*

Birthdate*

Email Address*
(please enter the same email address you used when creating your Common Application account)

Phone Number*
(please enter the same phone number used on the Common Application)

Common Application ID Number*
(usually 8-10 digits found on the top right of your Common Application login)

The below is required for you to receive your refund via wire transfer. If any of the below is incorrect you will not receive your refund, so please be careful in entering these details.

The full name as stated on the bank account*

The phone number as stated on the bank account (including country code)*

The address as stated on the bank account*

Country

Street

City

Region

Postal Code

Bank name*

Bank account or IBAN number*

SWIFT/BIC number*

Bank ABA or routing number*

Payment currency*

Please upload a PDF document on bank letterhead indicting the account and information to be refunded. This should include Swift code, account holders name, and account number or IBAN number depending on country.

Application Fee Reimbursement Form

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