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 (CNP)
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:
Date Board Approved: 1/20/2003
Date Board Updated/Reviewed: 3/21/2022