Refund Request Form

Refund Request Form

Child Nutrition Services Meal Account Refund Request Form
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Name*

Mountain Way ElementaryMonte Cristo ElementaryMiddle SchoolHigh SchoolCrossroads/Open Doors
Student Name*

First NameLast Name
Dollar Amount
Reason for Refund*

GraduateMoveDoes not eat school mealsReceives free or reduce priced mealsOther
Please select what you would like us to do with the money left in your account. If no box is checked, then a check will be sent to the payee at the address listed above.
Select one choice*

Full refund mailed to payeeTransfer funds to another student - see more information belowDonate to school to support students who need assistance paying for school meals
**If transferring funds to another student, list students full name below.
Refunds will be issued in 4-6 weeks. Transfer and donation requests will be processed within 7 days of receipt. Please use the submit button below once this form is complete. Questions you may have can be directed to ltipping@gfalls.wednet.edu.
Should be Empty: