Tutoring services refund request form

NEED HELP?

Contact Alexandra Plouffe by email at alexandra.plouffe@leucan.qc.ca or by phone at 514-731-3696, extension 1214.

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*

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 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*

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

A maximum amount of $ 500 per family will be available for tutoring services offered by recognized professionals between April 1^st 2021 and October 31^st 2021.

Please attach copies of invoices related to all your requests

Drop files here or

Max. file size: 200 MB.

Total amount of your family request*

Tutoring services refund request form

Refund form for tutoring services

NEED HELP?

Demande enfant #1

SUPPLIER DETAILS

Demande enfant #2

SUPPLIER DETAILS

Demande enfant #3

SUPPLIER DETAILS

REFUND

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