GCS Refund Request Form

GCS Refund Request Form

Please use this form to request a refund or transfer funds between students. We request the form be filled out as completely as possible. Refunds will be made payable to the parent or guardian. Please note: address provided will be used to mail the check.
Student's Name

Student First NameStudent Last Name
Student ID Number
Student Grade
Building Student Attends
Requestor's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address for Requestor
example@example.com
If requesting a Refund, please complete next fields.

If requesting a Transfer, please go towards bottom of the page and complete.
Refund Requested Amount
Refund for:
If Other, what is refund regarding:
Reason for Refund

(Only for School Nutrition Refund Requests) You have the option to have the School Nutrition refund amount go into the Angel Fund to help students in need. Please answer below:

Rows	Yes	No
Would you like to donate the School Nutrition refund balance to the Angel Fund?

Transfer Request - if you want funds transferred to another student's account, please complete the following information:
Transfer Request - additional student:
Transfer Request - additional student:
Comments or additional information:
Request Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty: