Cafeteria Account Refund/Transfer Form
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Cafeteria Account Refund/Transfer Form
Please call 601.499.0754 if you have questions. We will return your call as soon as possible.
1.
Date of Request:
mm/dd/yyyy
2.
Student Name:
*
3.
Please enter your location:
*
--Please Select--
Academic Options
Ann Smith
Camden Elem.
East Flora Elem.
Germantown High
Germantown Middle
Highland Elem.
Luther Branson Elem.
Madison Ave. Elem
Madison Ave. Upper Elem.
Madison Central High
Madison Crossing Elem.
Madison Middle
Madison Station Elem.
Mannsdale Elem.
Mannsdale Upper Elem.
Shirley D. Simmons Middle
Olde Towne Middle School
Ridgeland High
Velma Jackson Hgih
4.
Student ID or Lunch Number:
*
5.
Refund Amount (Leave blank if not sure.)
6.
Are you the parent/guardian of this student?
*
Are you the parent/guardian of this student?
*
Yes
No
7.
Enter your e-mail address:
8.
Are you requesting a refund or transfer?
*
Are you requesting a refund or transfer?
*
Refund
Transfer
9.
If you are requesting a refund, please provide Name, Address and Zip Code below.