Application for Refund to

Student Meal Account

Highland Food Services

Students Name____________________________________

Student’s ID Number______________________________

School____________________________________________

Refund Amount___________________________________

Reason for Refund_________________________________

___________________________________________________

Mailing Information

Name_____________________________________________

Address___________________________________________

___________________________________________________

Signature__________________________________________

Date_______________________________________________

Please submit this completed form to your school office or cafeteria. All refunds are subject to any balance owed to the Food Service Department for charged meals. Checks will be processed and mailed to the above address once the refund is approved. This process may take up to 6 weeks. Inquiries can be directed to Debra Barker, Food Service Director– 219-922-5646 ext 7233.