503.03 E1 - Fines-Fees-Charges-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 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 (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 or actual custodian

 

Approved: January 12, 2026

Reviewed: January 12, 2026

Revised: January 12, 2026