Athena's Specialized Receipt Form

Families paying via PayPal, credit, or debit card automatically receive
a receipt from the PayPal interface.

Please fill out this form if a specialized receipt is needed.

This form includes a non-refundable $5.00 processing fee.

Before filling out this form, please gather your PayPal receipts and the course descriptions of the courses linked here: https://athenasacademy.com/courses/

Parent Full Name *

Parent Email Address *

Student Full Name *

Specialized Receipt's Date.

This is not the date of the course. This is the date of the receipt. The receipt date may be specialized. For example, if a fall course was purchased in March, we can date the receipt for September if needed. *

PayPal Transaction Number(s).

The PayPal Merchant Transaction ID number can be found on the PayPal receipt sent to your corresponding email address. Please separate multiple Merchant Transaction ID numbers by commas. *

Course Names, Course Dates, and Course Cost.

Course Names and Dates are found on the Course Description Webpages: https://athenasacademy.com/courses/
AND in the corresponding course classroom via https://athenasacademy.myopenlms.net/

Course cost is on your PayPal receipt.

Please place each course name and its information on a new line.

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Specialized Receipts will also include the following:

*Athena's Name

*Athena's Address

*Athena's Contact Information including Admin. Signature

*The indication that the courses are Paid in Full

Besides the information above, please list anything else that should be listed on the Specialized Receipt.

If you would like to share any other information with us, please use the space below.

Terms and Conditions: Indicate your agreement by clicking the button below. *

I attest that the information I included above is accurate.

Electronic Signature

Please electronically sign this document, indicating your agreement to the condition stated above. *

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Non-Refundable Specialized Receipt Fee *

Non-Refundable Specialized Receipt Fee ($5.00)

Current Total:

$0.00