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 or actual custodian:____________________________
Please check type of waiver desired:
Full waiver________ 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 Child Nutrition Program
_________ The Family Investment Program (FIP)
_________ Supplemental Security Income (SSI)
_________ Transportation assistance under open enrollment
_________ Foster care
Partial waiver
_________ Reduced priced meals offered under the Child 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 or actual custodian:____________________________________________________
Note: Your signature is required for the release of information regarding the student or the student's family financial eligibility for the purpose checked above.
Revised/Reviewed: April 22, 2024
The board recognizes that while certain fees charged students are appropriate and authorized, certain students and their families are not financially able to pay the fees. The school district will grant either full waivers, partial waivers or temporary waivers depending upon the circumstances and the student or student's parents' ability to meet the financial criteria.
Students whose families meet the income guidelines for free and reduced price lunch, the Family Investment Program (FIP), Supplemental Security Income (SSI), transportation assistance under open enrollment or who are in foster care are eligible to have their student fees waived or partially waived. Students whose families are experiencing a temporary financial difficulty may be eligible for a temporary waiver of student fees. Parents or students who believe they may qualify for temporary financial hardship should contact the secretary for a waiver form. This waiver does not carry over from year to year and must be completed annually.
Revised/Reviewed: April 22, 2024