Home Tutoring services refund request form

Tutoring services refund request form

Refund form for tutoring services

NEED HELP?
Contact Jocelyne Ndarabu by email at jocelyne.ndarabu@leucan.qc.ca or by phone at 514-731-3696, extension 1234.
Name of child diagnosed with cancer*
First Name Name
Name of the parent making the request*
First Name Name
Phone number*
Second phone number
Email of the parent making the request*
Choose your region*
Address*
City*
Postal code*
Hidden
Demande enfant #1
Name of the child who received the tutoring service*
First Name Name
School level of the child who received the tutoring service*
Type of service*
Supplier’s name
First Name Name
Phone number
Email
Postal address
City
Postal code
Do you wish to complete a form for another child?*
- Yes
- No
Hidden
Demande enfant #2
Name of the child who received the tutoring service*
First Name Name
School level of the child who received the tutoring service*
Type of service*
Were the services provided by the same supplier?*
- Yes
- No
SUPPLIER DETAILS
Note: Tax statements will be issued to self-employed workers, retired professors or students. Full contact details must be provided. The supplier’s social insurance number will be requested in the future.
Supplier’s name
First Name Name
Phone number
Email
Postal address
City
Postal code
Hidden
Demande enfant #3
Do you wish to complete a form for another child?*
- Yes
- No
Name of the child who received the tutoring service*
First Name Name
School level of the child who received the tutoring service*
Type of service*
Were the services provided by the same supplier?*
- Yes
- No
SUPPLIER DETAILS
Note: Tax statements will be issued to self-employed workers, retired professors or students. Full contact details must be provided. The supplier’s social insurance number will be requested in the future.
Supplier’s name
First Name Name
Phone number
Email
Postal address
City
Postal Code
REFUND
You may be reimbursed up to $600 per child for tutoring services provided by recognized professionals throughout the school year. Reimbursement may be higher, based on an assessment of your request and the funds remaining in the program.
Please attach copies of invoices related to all your requests
Drop files here or

Max. file size: 50 MB.
Total amount of your family request*

Tutoring services refund request form

Refund form for tutoring services

NEED HELP?

Demande enfant #1

Demande enfant #2

SUPPLIER DETAILS

Demande enfant #3

SUPPLIER DETAILS

REFUND

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