Account Refund/Transfer Request Form

Account Refund/Request Form

 

Student Information (account requesting refund from):

Last Name: 

First Name: 

School: 

 

Reason for refund:

 Left School District
 Graduated
 Other     Specify: 
 

Anticipated amount of refund:  $

 

Please indicate how you would like to receive refund from the following 3 options:

 Paper Check

Parent/Legal Guardian to make check payable to:   
First / Last Name  
Address 
City   State   Zip  

 

 Transfer to another student's account

Student First/Last Name 
Grade 
School  

 

 Donate funds to SMCSC Donation Account
This fund is used to provide extra help to students whose parents struggle to keep cafeteria accounts current.

 

Person completing this form:

First/Last Name: 
Email Address: 

 



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