Nutritional Services Refund Request

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Please complete this form to request a meal account refund, transfer money to another sibling's lunch account or donate money to the district's Angel Fund. Meal account refunds are only issued for amounts greater than $10.00 in the student's account. If you have any questions please contact Kathy Backstrom at 763-502-5021. Thank you.

Email *

Parent/Guardian Last Name *

Parent/Guardian First Name *

Parent/Guardian Phone Number *

Student Last Name to transfer from *

Student First Name to transfer from *

YYYY

Student's Lunch Pin Number to transfer from

What are you looking to do? *

I would like a refund from my child's lunch account. Refunds are only issued on a lunch balance greater than $10.00

I would like to transfer funds to another siblings account

I would like to donate funds from my child's lunch account to the Angel fund

If transferring money to another sibling's account please provide that student's first and last name, date of birth and lunch pin number below.

If requesting a refund, please include who the check is payable to, relationship to student, and mailing address.

Parent/Guardian Signature. I understand and agree that my electronic signature is the equivalent of a manual signature. *

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