CHILD NUTRITION STUDENT REFUND REQUEST
STUDENT INFORMATION
Date of Request :
Student Name :
Student ID Number:
DISD Campus:
PARENT INFORMATION
Parent/Guardian Name:
Parent/Guardian Phone Number:
Mailing Address for Refund:
Amount of Refund:
$
SIGNATURES
Please refund the total credit balance of this account to the address shown above
Parent/Guardian Signature
Date
Manager’s Signature
Date
Please return this form to the DISD Child Nutrition Department in one of the following ways:
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

Email: bmartin2@dentonisd.org
Fax: 940-387-3402
Mail: Child Nutrition Department
Attn: Beverly Martin
230 North Mayhill Road
Denton, TX 76208
Please note: The refund processing time is 6 – 8 weeks