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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


Student Info

Refund Amount

Reason for Refund

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