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
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 Children Nutrition Program
__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____________
Adopted: Unknown
Revised/Reviewed: 4.20.2020
