Date_____________________________                                                School year_____________

 

Name of student(s):____________________________                            Grade in school __________

    ____________________________                                                     __________

    ____________________________                                                     __________

    ____________________________                                                     __________

    ____________________________                                                     __________

 

To be eligible for FULL WAIVER, you or your child must meet one or more of the following guidelines:

Free meals offered under the Child Nutrition Program
The Family Investment Program (FIP)
Supplemental Security Income (SSI)
Transportation assistance under open enrollment
Foster Child

To be eligible for PARTIAL WAIVER, you must meet the following criteria:

      Reduced –priced meals offered under the Child Nutrition Program

Please circle the type of waiver that you believe you are eligible to receive:

                                           Full Waiver                                                Partial Waiver               

If you child(ren) qualifies for free or reduced price meals, you may also be eligible for other benefits. Some of these benefits are Book Rent, Computer Rent, Accounting
I and II, Vocal Text  Fee/Sr. High, Cleaning Fee/Band/Sr. high, Music Text Fee 5-8, Driver Education and CPR 9^th grade.  If you sign this waiver, your child(ren) will be
considered for a full or partial waiver of Book rent, Computer Rent, Accounting I and II, Vocal/Text Fee/Sr. high, Cleaning Fee Band High, Music Text Fee 5-8, Driver’s
Education and CPR 9th grade. I understand that I will be releasing information that will show that I applied for free and reduced price school meals for my child(ren). I
give up my rights to confidentiality for waiver of school fees ONLY.

I certify that I am the parent/guardian of the child(ren) for whom application is being made.

 

Signature of parent, guardian:_____________________________________________________________
  or legal or actual custodian

 

YOU DO NOT HAVE TO COMPLETE THIS WAIVER TO GET FREE OR REDUCED PRICE SCHOOL MEALS, BUT DO NEED TO COMPLETE IN ORDER
TO RECEIVE FREE OR REDUCED PRICE ON  SCHOOL FEES.

NOTE:  Your signature is required for the release of information regarding the student or this student's family financial eligibility for the program checked above.

 

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. 

      The reduction percentage will be 40 percent.

                  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 school board.

        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 superintendent's office for
a waiver form.  This waiver does not carry over from year to year and must be completed annually.