MEAL ACCOUNT - Reimbursement Form
Sign in to Google to save your progress. Learn more
Email *
Prior to requesting a refund, please make sure that all auto payments are turned off in MySchoolBucks.  Failure to do so could result in payments being deducted when the account reimbursement is initiated.  SESD is unable to see if auto pays are set up or turn them off!
Student's Full Name *
Student's Grade Level *
Parent/Guardian Full Name *
Home Street Address *
City *
State *
Zip code *
A) Instead of a refund or transfer, I wish to DONATE my remaining balance to a student in need. *
B) Name of the student or staff account to whom the balance should be TRANSFERRED.
C) Name of student or parent to whom the REFUND check should be issued.
SIGNATURE (Parent/Guardian/Student must be 18 years of age or older to sign)
Please type your full name below, as this shall represent your electronic signature.
Signature - (Type your full name) *
Checks will be mailed after confirming the meal account balance.
Go to for balance inquiries.  For all other inquiries, contact the Director of Dining Services, Emily Kobel, at (717) 382-4843 ext. 6850 or by email: 
Clear form
Never submit passwords through Google Forms.
This form was created inside of South Eastern School District. Report Abuse