Account Refund/Transfer Request Form

Account Refund/Request Form


Student Information (account requesting refund from):

Last Name: 

First Name: 



Reason for refund:

 Left School District
 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  
City   State   Zip  


 Transfer to another student's account

Student First/Last Name 


 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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