Code No. 503.3E1
STANDARD FEE WAIVER APPLICATION
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All information provided in connection with this application will be kept confidential. |
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Name of student: |
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Grade in school |
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Name of student: |
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Grade in school |
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Name of student: |
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Grade in school |
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Attendance Center/School: |
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Name of parent, guardian: or legal or actual custodian |
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Please check type of waiver desired: |
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Full waiver |
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Partial waiver |
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Temporary waiver |
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Please check if the student or the student's family meets the financial eligibility criteria or is involved in one of the following programs: |
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Full waiver |
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Free meals offered under the Children Nutrition Program (CNP) |
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The Family Investment Program (FIP) |
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Transportation assistance under open enrollment |
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Foster care |
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Partial waiver |
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Reduced priced meals offered under the Children Nutrition Program |
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Temporary waiver |
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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: |
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Signature of parent, guardian: or legal or actual custodian |
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