503.03E1 Standard Fee Waiver

503.3E1

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:  _______

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          

Please check if the student or the student's family meets the financial eligibility criteria or is involved in on of the following programs:

Full Waiver:

_____     Free meals offered under the Child Nutrition Program(CNP)

_____     The Family Investment Program(FIP)

_____     Transportation assistance under open enrollment

_____     Foster Care

Partial Waiver:                       

     _____      Reduced priced meals offered under the Child Nutrition Program

 

Name of parent, guardian:  _____________________________________________                                                                                   or legal or actual custodian:  

Cross Reference:

    501.16    Homeless Children and Youth

Approved:  02/10/1997    Reviewed: 03/18/2024    Revised: 03/18/2024