502.11F STUDENT FEES WAIVER AND REDUCTION FORM
Dear Parent or Guardian,
If your child(ren) qualify for free or reduced price meals, you may also be eligible for other benefits. One of the benefits is some class fees. (This does not include activity pass fees.) Complete this form and return with your application for free/reduced price meals.
____YES, I wish to apply for a waiver of payment of other school fees (not activity pass fees) for my student(s). School personnel may release my student(s) free and reduced-price meal eligibility status to determine eligibility for school fee waivers.
I understand that, if I apply for a waiver of fees, 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 other school fees. This authorization is in effect for one (1) year. I understand that I may revoke this release in writing at any time.
____NO, I do not wish to apply for a waiver of payment of other school fees for my student(s).
I certify that I am the parent/guardian of the child(ren) for whom the application is being made.
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Printed Name of Parent/Guardian
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Signature of Parent/Guardian
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Date Signed
*Adopted: 12/13/10
*Revised: 10/08/12
*Reviewed: 08/14/17
*Reviewed: 8/1/22
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