Meal Plan Cancellation Term (Fall or Spring and year)
Name______________________________________________________________ Date____________________________________
Signature___________________________________________________________ CLARION ID____________________________
By signing this form I give the Residence Life Office permission to cancel my meal plan. I understand any unused flex
dollars will be removed from my account at the time of cancellation. There is no refund for unused flex dollars.
Please return this card to the Center for Residence Life Services, 218 Becht Hall, Clarion University of PA, Clarion,
PA 16214.
For office use: Processed _______________ Date _____________ Initials
________ Staff Initials
Please type your full name in place of your signature
Please download and save the form to your computer. Complete the form and save it to your computer. Email the
completed for back to reslife@clarion.edu If you have any questions, please call 814-393-2352.