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, 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 temporary waivers depending upon the circumstances and the student or student’s parents’ ability to meet the financial criteria.
Application – Parents or students 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.
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.
Fines or charges assessed for damage or loss to school property are not fees and will not be waived.
I request a temporary waiver because:
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Signature of parent, guardian, legal or actual custodian: ______________________________________
