POWAY UNIFIED SCHOOL DISTRICT
Food and Nutrition Department
School Meal Money Refund/Transfer Form
Please complete this form and send to: Food and Nutrition Department, 12225 Kirkham Road,
Suite 100, Poway, CA 92064-8847, FAX (858) 486-1805 or E-Mail:
Student ID Student Name School Name Amount
TOTAL:
Refunds of $15.00 or more may be paid by check and mailed. Refunds of less than $15.00 may
be picked up from the Food and Nutrition Department at 12225 Kirkham Road, Suite 100, Poway,
CA 92064-8847.
PLEASE CHECK ONE OF THE FOLLOWING:
DONATION – Please keep my refund and use it as a donation to
help needy families pay for their meals.
TRANSFER – Please transfer my refund amount to the following
sibling/household member(s).
Student Name Student ID and School Name Amount
REFUND – Please send my refund of $15.00 or more to the following:
Parent/Guardian Name:
Address:
City, State, ZIP:
Phone: ( ) E-mail:
REFUND – Please notify me when to pick-up my refund of less than $15.00.
Reason for Refund: Moving out of District
End of School Year Refund
Other
Parent/Guardian Signature:
Date:
Please note that a student’s meal account money is automatically carried over to the next school year
EXCEPT after completion of the 12th grade. If your child will not be attending a school within the Poway
Unified School District, his/her money will be transferred to another sibling in your family or refunded after
completion of this form. Please allow 30 days for your request to be processed. Please contact the Food
and Nutrition Department office at (858) 668-2562 or e-mail: elaguda@powayusd.com if you have
any questions or need clarification.
Office Use Only:
Amount Refunded/Transferred: $
Accountant Signature: Date:
