503.3E1 - Standard Fee Waiver Application

Date                                                     School Year                                       

All information provided in connection with this application will be kept confidential.

   

Name of Student:                                                                                                      Grade in School:                                

Name of Student:                                                                                                      Grade in School:                                

Name of Student:                                                                                                      Grade in School:                                

Attendance Center / School:                                                                                                                                                 

Name of Parent / Guardian: (or Legal / Actual Custodian)                                                                                                    

  

Please check type of waiver desired:

Full Wavier                                Partial Waiver                                Temporary Waiver                              

Please check if the student or the student's family meets the financial eligibility criteria or is involved in one of the following programs:

Full waiver

              Free meals offered under the Children Nutrition Program (CNP)

              The Family Investment Program (FIP)

              Transportation assistance under open enrollment

              Foster care

Partial waiver

              Reduced priced meals offered under the Children Nutrition Program

Temporary waiver

If none of the above apply, but you wish to apply for a temporary waiver of school fees because of serious financial problems, please state the reason for the request:

                                                                                                                                                                                         

Signature of Parent / Guardian: (or Legal / Actual Custodian)                                                                                               

 

 

Approved: August 1996                    
Reviewed: February 2017, May 2020
Revised: May 2009