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Student Nutrition Services - Request for Refund

This form is to be filled out by the parent of a student enrolled or previously enrolled in Hillsborough County Public Schools to request a refund from prepayment funds deposited in a child's account. One form is required per child. The District Office will send a check for all refund requests to the parent's home address.

*Note: By completing this form you are certifying that the person below is listed on the students' "Emergency Contact Card".

Parent Info

Address

Student Info

Refund Amount

Reason for Refund

Does student have a MyPaymentsPlus Account? (If yes, auto replenish must be canceled before refund is processed.)