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 wavier 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

 

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.

        A.      Waivers -

                  1.   Full Waivers - a student will be granted a full waiver of fees charged by the school district if the student or student's parents meet the financial eligibility criteria for free meals under the Child Nutrition program, Family Investment Program, or transportation assistance under open enrollment.  Students in foster care are also eligible for full waivers.

2.   Partial Waivers - a student will be granted a partial waiver of fees charged by the school district if the student or the student's parents meet the financial eligibility criteria for reduced price meals offered under the Child Nutrition program.  A partial waiver is based on the same percentage as the reduced price meals.

                  3.   Temporary Waivers - a student may be eligible for a temporary waiver of fees charged by the district in the event the student's parents are facing financial difficulty.  Temporary waivers may be applied for at any time throughout the school year and will not extend beyond the end of the school year.

        B.       Application - Parents or students eligible for a fee waiver will make an application on the form provided by the school district.  Applications may be made at any time but must be renewed annually.

        C.       Confidentiality - The school district will treat the application and application process as any other student record and student confidentiality and access provisions will be followed.

        D.      Appeals - Denials of a waiver may be appealed to the Superintendent.

        E.       Fines or charges assessed for damage or loss to school property are not fees and will not be waived.

        F.       Notice - the school district will annually notify parents and students of the waiver.  The following information will be included in registration materials.

Students whose families meet the income guidelines for free and reduced price lunch, the Family Investment Program (FIP), or 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 principal for a waiver form.  This waiver does not carry over from year to year and must be completed annually.