Refund Request
Refunds will be issued in the order in which they are received. Refunds will be processed within 2-3 weeks of request depending on volume of requests.

Before completing this form, please make sure your auto-replenish is turned off on TITAN by logging into your account at family.titank12.com.

Thank you!
Sign in to Google to save your progress. Learn more
Email *
Parent/Guardian Full Name *
Student First Name *
Student Last Name *
Student Date of Birth *
MM
/
DD
/
YYYY
Student ID Number
Check here if you would like the remaining funds to be donated to the Angel Fund to help a student in need.
Clear selection
Reminder: TITAN auto replenish must be turned off, or else an automatic payment will be made after the refund is processed. Login to your account at family.titank12.com before completing this form to ensure auto-replenish is disabled.
Complete Address: For check to be mailed when selecting refund.  *
Email
If you would like the remaining funds transferred to another student, please provide the Student ID Number of account where funds will be transferred to.  If the funds are to be transferred to multiple students, please list them below and how much should go to each.
USDA Nondiscrimination Statement
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.

Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:

(1)           Mail: U.S. Department of Agriculture

Office of the Assistant Secretary for Civil Rights

1400 Independence Avenue, SW

Washington, D.C. 20250-9410;

(2)           Fax: (202) 690-7442; or (3) Email: program.intake@usda.gov.

This institution is an equal opportunity provider.

Iowa Non-Discrimination Statement:  “It is the policy of this CNP provider not to discriminate on the basis of race, creed, color, sex, sexual orientation, gender identity, national origin, disability, age, or religion in its programs, activities, or employment practices as required by the Iowa Code section 216.6, 216.7, and 216.9.  If you have questions or grievances related to compliance with this policy by this CNP Provider, please contact the Iowa Civil Rights Commission, Grimes State Office building, 400 E. 14th St. Des Moines, IA 50319-1004; phone number 515-281-4121, 800-457-4416; website: https://icrc.iowa.gov/.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Urbandale Community School District. Report Abuse