MEAL ACCOUNT - Reimbursement Form
Email address *
Student's Full Name *
Student's Grade Level *
Parent/Guardian Full Name *
Home Street Address *
City *
State *
Zip code *
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.
Go to for balance inquiries. For all other inquires, contact the Director of Dining Services, Karen Graham, at (717) 382-4843 ext. 6850 or by email:
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