503.3E1 - Standard Fee Waiver Application

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 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 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:  11/16/2020                       Reviewed: 10/19/2020            Revised:   10/19/2020