Business, Consumer Services and Housing Agency ﾱ Governor Edmund G. Brown
Jr.
Bureau for Private Postsecondary Education
2535 Capitol Oaks Drive, Suite 400, Sacramento, CA 95833 P.O. Box 980818, West Sacramento, CA 95798-0818
P (916) 431-6959 F (916) 263-1896 www.bppe.ca.gov
Application for Student Tuition Recovery Fund
Dear Student:
The Bureau for Private Postsecondary Education (Bureau) is committed to ensuring students receive appropriate refunds from Student Tuition Recovery Fund (STRF) account, in accordance with applicable laws and regulations.
In order to help us expedite your claim please complete and sign the STRF application and provide us with the following documents:
ｸProof of Enrollment - School Enrollment Agreement
ｸReceipts: All receipts for tuition payments and or student loan payments
OIf you paid for tuition with a credit card please contact our office for special instructions
ｸLoan Documents ﾱ＃Provide copy of loan documentation
ｸLoan Discharge Response ﾱ＃The response from the loan company when you requested a loan discharge.
ｸLeave of Absence (LOA) documentation if you took a LOA
ｸProof of STRF assessment payment if the payment is not listed on your enrollment agreement
Copies of documents are preferred; originals are not necessary. The Bureau will not accept a faxed application.
Please provide the applicable information above along with your completed signed STRF Claim Application. Copies of documents are preferred; originals are not necessary. The Bureau makes every effort to pay
student STRF claims in a timely manner. Providing the Bureau has all the requested documents up front ｌｐｓｕｒｙｈｖ＃ｗｋｈ＃Ｅｘｕｈｄｘﾶｖ＃ｗｘｕｑｄｕｒｘｑｇ＃ｗｌｐｈ１＃
You can submit your application and documents to the above listed address.
Should you have any questions, or require additional information, please contact the STRF unit at 888-370- 7589 and select option 5 when prompted, or you may send an email to STRF@dca.ca.gov
Respectfully,
Student Tuition Recovery Fund Unit
Bureau for Private Postsecondary Education
Form STRF App Rev. 8/14 |
Page 1 of 5 z |
Bureau for Private Postsecondary Education
P.O. Box 980818
West Sacramento, CA 95798-0818
OFFICE USE ONLY
Date Stamp
SAIL application # _____________________
SchoolutsrCode Closure date
Application for Student Tuition Recovery Fund
(California Education Code § 94924; Title 5, California Code of Regulations § 76200)
STUDENT
Name:
Address:
Phone Number:
Email Address:
Social Security Number:
INSTITUTION
Name
Address
City |
State |
Zip |
Telephone Number |
|
|
DATES OF ATTENDANCE
Date started: |
Date stopped: |
Graduated: |
No___________ Yes_________ If Yes When________ |
|
|
Reason you stopped attending the institution:
|
|
5 z |
Form STRF App Rev. 8/14 |
Page 2 of |
STUDENT TUITION RECOVERY FUND (STRF)
CHECK ALL THAT APPLY
The fund exists to relieve or mitigate pecuniary losses suffered by a California resident who is or was a student of a qualifying institution if the student enrolled in an institution, prepaid tuition, paid the assessment, and suffered loss as a result of any of the following reasons per California Education Code Section 76020. Please check:
The closure of the institution.
Ｗｋｈ＃ｌｑｖｗｌｗｘｗｌｒｑﾶｖ＃ｉｄｌｏｘｕｈ＃ｗｒ＃ｓｄ｜＃ｕｈｉｘｑｇｖ＃ｒｕ＃ｆｋｄｕｊｈｖ＃ｒｑ＃ｅｈｋｄｏｉ＃ｒｉ＃ｄ＃ｖｗｘｇｈｑｗ＃ｗｒ＃ｄ＃ｗｋｌｕｇ＃ｓｄｕｗ｜＃ｉｒｕ＃ｏｌｆｈｑｖｈ＃ｉｈｈｖ＃ｒｕ＃ｄｑ｜＃
other purposes, or to provide equipment or materials for which a charge was collected within 180 days before the closure of the institution.
Ｗｋｈ＃ｌｑｖｗｌｗｘｗｌｒｑﾶｖ＃ｉｄｌｏｘｕｈ＃ｗｒ＃ｓｄ｜＃ｒｕ＃ｕｈｌｐｅｘｕｖｈ＃ｏｒｄｑ＃ｓｕｒｆｈｈｇｖ＃ｘｑｇｈｕ＃ｄ＃ｉｈｇｈｕｄｏｏ｜＃ｊｘｄｕｄｑｗｈｈｇ＃ｖｗｘｇｈｑｗ＃ｏｒｄｑ＃ｓｕｒｊｕｄｐ＃ as required by law or to pay or reimburse proceeds received by the institution prior to closure in excess of tuition and other costs.
A decline in the quality or value of the course of instruction within the 30-day period before the closure of the institution or, if the decline began before the period, the period of decline determined by the Bureau.
Ｗｋｈ＃ｖｗｘｇｈｑｗﾶｖ＃ｌｑｄｅｌｏｌｗ｜＃ｗｒ＃ｆｒｏｏｈｆｗ＃ｄ＃ｍｘｇｊｐｈｑｗ＃ｈｑｗｈｕｈｇ＃ｄｊｄｌｑｖｗ＃ｄ＃ｔｘｄｏｌｉ｜ｌｑｊ＃ｌｑｖｗｌｗｘｗｌｒｑ／＃ｖｘｅｍｈｆｗ＃ｗｒ＃ｄｏｏ＃ｒｉ＃ｗｋｈ＃ following:
The student has reasonably tried, and failed, to collect on the judgment.
The Bureau receives the studentﾶｖ＃ｄｓｓｏｌｆｄｗｌｒｑ＃ｚｌｗｋｌｑ＃７＃｜ｈｄｕｖ＃ｉｕｒｐ＃ｗｋｈ＃ｖｆｋｒｒｏﾶｖ＃ｆｏｒｖｘｕｈ１
The student has not received reimbursement or forgiveness from any other source.
GENERAL INFORMATION
Were you a California resident at time of enrollment? |
Yes |
No |
Did you pay the STRF fee? (Check enrollment agreement) |
Yes |
No |
Did you ever take a leave of absence during the time of |
Yes |
No |
enrollment? (Attach copies of approved leave) |
|
|
Do you hold a student Visa or Temporary Workers Visa? |
Yes |
No |
Have you previously applied for a STRF reimbursement? |
Yes |
No |
Did the course of study or the portion completed, prepare |
|
|
you or allow you to take a state or national licensure exam? |
Yes |
No |
If Yes, provide the licensure exam title. |
|
|
Did you transfer to another school? |
|
|
If Yes, provide a copy of enrollment agreement from new |
Yes |
No |
school and list any classes or units transferred. |
|
|
Did you obtain a court judgment against the school? |
Yes |
No |
If Yes, attach a copy. |
|
|
ECONOMIC LOSS
Please document the amount and provide a description of your economic loss:
Tuition:
Other Costs: (provide itemized list)
Amount of Claim:
(Total amount requesting)
YOU MUST PROVIDE A COPY OF YOUR ENROLLMENT AGREEMENT, RECEIPTS AND ALL OTHER DOCUMENTS TO SUBSTANTIATE YOUR EXPENSES.
Enrollment agreement copy attached: _____ Yes _____ No |
|
All copies of receipts for monies paid including cash and loans attached. _____ Yes |
_____ No |
Copies of Promissory Notes, Loan Documents attached. _____ Yes _____ No |
Page 3 of 5 z |
Form STRF App Rev. 8/14 |
PAYMENT INFORMATION
Did you receive assistance from a third party (including, but not limited to workers compensation, vocational rehabilitation, insurance company, military, etc.) to pay any part of the tuition?
Yes No
If YES, provide documentation detailing the assistance received.
Did you pay cash for tuition? |
Yes No |
If YES, provide copies of all receipts, the school ledger card showing payments, statement from the school showing paid in full, credit card statements, canceled checks (front and back).
Did you receive a loan of any type (including guaranteed student loan, private loan, retail installment agreement,
PLUS, NDSL, SLS, CLAS, Stafford, etc.) to pay any part of the tuition? |
Yes No |
If YES, provide the name of the lender, any state or federal agency that guaranteed or reinsured the loan, and the most current loan statement.
Were payments made on the loan(s)? |
Yes No |
If YES, provide documentation of all payments, provide copies of canceled checks (front and back), charge slips, receipts, payment history from the bank, etc.
ﾳＬ＃ｇｈｆｏｄｕｈ＃ｘｑｇｈｕ＃ｓｈｑｄｏｗ｜＃ｒｉ＃ｓｈｕｍｘｕ｜＃ｘｑｇｈｕ＃ｗｋｈ＃ｏｄｚｖ＃ｒｉ＃ｗｋｈ＃Ｖｗｄｗｈ＃ｒｉ＃Ｆｄｏｌｉｒｕｑｌｄ＃ｗｋｄｗ＃ｗｋｈ＃ｉｒｕｈｊｒｌｑｊ＃
and all attachments are true and correｆｗ１ﾴ＃
Signature |
Date |
Print Name |
|
Form STRF App Rev. 8/14 |
Page 4 of 5 z |
Business, Consumer Services and Housing Agency ﾱ Governor Edmund G. Brown
Jr.
Bureau for Private Postsecondary Education
2535 Capitol Oaks Drive, Suite 400, Sacramento, CA 95833 ywvusronmP.O. Box 980818, West Sacramento, CA 95798-0818
P (916) 431-6959 F (916) 263-1896 www.bppe.ca.gov
LOAN NEGOTIATION, CERTIFICATION, AND AUTHORIZATION
1.By signing this form you authorize the Bureau to negotiate with any lender, holder, guarantee
ageｑｆ｜／＃ｒｕ＃ｗｋｈ＃Ｘ１Ｖ１＃Ｇｈｓｄｕｗｐｈｑｗ＃ｒｉ＃Ｈｇｘｆｄｗｌｒｑ＃ｒｑ＃ｗｋｈ＃ｖｗｘｇｈｑｗﾶｖ＃ｅｈｋｄｏｉ＃ｗｒ＃ｕｈｇｘｆｈ＃ｗｋｈ＃ｏｒｄｑ＃ｒｅｏｌｊｄｗｌｒｑ１＃
2.By signing this form you authorize the Bureau to issue a payment directly to any lender, holder, guarantee agency, or the U.S. Department of Education on the sｗｘｇｈｑｗﾶｖ＃ｅｈｋｄｏｉ１＃
3.Ｄｑ＃ｄｖｖｌｊｑｐｈｑｗ＃ｗｒ＃ｗｋｈ＃Ｉｘｑｇ＃ｄｑｇ＃ｗｋｈ＃Ｅｘｕｈｄｘ＃ｒｉ＃ｗｋｈ＃ｖｗｘｇｈｑｗﾶｖ＃ｕｌｊｋｗｖ＃ｗｒ＃ｆｒｏｏｈｆｗ＃ｗｋｒｖｈ＃ｉｘｑｇｖ＃ｄｊｄｌｑｖｗ＃ｗｋｈ＃ institution if any payment issues as a result of the application.
TO WHOM IT MAY CONCERN, I AUTHORIZE THE RELEASE OF MY LOAN INFORMATION TO A REPRESENTATIVE OF THE BUREAU FOR PRIVATE POSTSECONDARY EDUCATION FOR THE SOLE PURPOSE OF LOAN NEGOTIATION ON MY BEHALF.
Ｖｗｘｇｈｑｗﾶｖ＃
Full Name:
Ｖｗｘｇｈｑｗﾶｖ＃
Social Security Number:
Ｖｗｘｇｈｑｗﾶｖ＃ Signature:
Date:
Borrower if different than student
Full Name:
Borrower
Social Security Number:
Ｅｒｕｕｒｚｈｕﾶｖ＃ Signature:
Date:
Form STRF App Rev. 8/14 |
Page 5 of 5 z |
