MEAL ACCOUNT - Reimbursement Form
STUDENT / PARENT INFORMATION
Student's Full Name
Student's Grade Level
Parent/Guardian Full Name
Home Street Address
Funds in the Meal Account will roll to the 2020-2021 school year automatically. Seniors may request refund or transfer of the meal balance by completing ONE of the options below:
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.
for balance inquiries. For all other inquires, contact the Director of Dining Services, Karen Graham, at (717) 382-4843 ext. 6850 or by email:
Send me a copy of my responses.
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This form was created inside of South Eastern School District.