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

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


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