Lake Dallas ISD Child Nutrition Department - Student Refund Request Form

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Please complete the form below to request a refund on your student's lunch account.

Email *

Today's Date *

YYYY

Student Full Name *

Student's Campus *

LDHS

LDMS

LDE

SSE

Required

LDISD Cafeteria Account Balance

Please DONATE the remainder of my student's lunch balance to a student in need.

Yes

Please TRANSFER the remainder of my student's lunch balance to a sibling/family member's account. Please provide name of student to receive the transfer in the space provided.

Yes

Other:

Clear selection

Please REFUND my student's lunch account balance.

Yes

If you wish to receive a REFUND, please provide a mailing address.

Parent/Guardian Name *

Parent/Guardian Phone # *

Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. * *

I Accept

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