Form Strf App PDF Details

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QuestionAnswer
Form NameForm Strf App
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesstrf_assessment bppe student tuition recovery fund form

Form Preview Example

Business, Consumer Services and Housing Agency 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:

Proof of Enrollment - School Enrollment Agreement

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

Loan Documents ᄆ#Provide copy of loan documentation

Loan Discharge Response ᄆ#The response from the loan company when you requested a loan discharge.

Leave of Absence (LOA) documentation if you took a LOA

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:

City

State

Zip

 

 

 

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.

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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.

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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.

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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 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

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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.

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Full Name:

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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

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A way to prepare Form Strf App step 1

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A way to complete Form Strf App part 2

Lots of people frequently get some things wrong while filling out Respectfully in this area. You should definitely go over whatever you enter here.

3. The following part is all about STUDENT Name, Address, City Phone Number Email Address, Zip, Zip, State, and State - fill out all of these empty form fields.

How one can complete Form Strf App part 3

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Page  of, No Yes If Yes When, and City Phone Number Email Address of Form Strf App

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