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
