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Refund Request Form
Please complete this form if you have registered for the Excellence In Action Summer Program for July 13th-July 17th or July 27th -July 31st and would like a refund.
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* Indicates required question
Student’s Last Name
*
Your answer
Student's First Name
*
Your answer
Please indicate which session your student was to attend
*
Session 1, July 13th - 17th
Session 2, July 27th - July 31st
Parent /Guardian Name
*
Your answer
Parent/Guardian Email Address:
*
Your answer
Parent Phone Number
*
Your answer
Mailing Address:
*
Your answer
Please indicate how you payed for the program.
*
Online payment site, My School Bucks .com
Check
Cash
Other:
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