Request for Refund on Student’s Lunch Account

Request for Refund on Student's Lunch Account

Date _______________________________

I request a refund from my child's lunch account.

Refund Policy: Refund will be applied to any outstanding balance due to the district before a check can be issued. Monies remaining can be applied to a sibling's account. Refund checks will only be issued for amounts of $10.00 or greater, when requested by May 31st following the payment year. Refund requests for balances greater than one year old will not be granted. (ie if your student graduated in 2017, your refund must be requested by 5/31 of 2018.)

Students' names/ID:

1. _________________________ID: __________School:__________$_________

2. _________________________ID: __________School:__________$_________

3. _________________________ID: __________School:__________$_________

Parent/Guardian Name and address

(must be completed)

________________________________________ ________________________________________ ________________________________________

Relationship to child(ren): ________________________________________

Or

Transfer Balance from Student(s) listed above to:

Name/ID:

_______________________________ ID:__________

Reason for Refund : ______________________________________________________

Signature _____________________________________________________

Form must include Parent/Guardian Signature

Fill out this form and mail to the Nutrition Services Office at 365 Raider Way, Bolingbrook, IL 60440. Signed Form can be faxed to: Fax: 630/771-2937 or emailed to: nutritionservices@ Questions: 630/7712931

A refund will be issued to the requestor (Parent or Guardian only) and mailed to the address given above. Outstanding school fees will addressed before refunds are made.

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