537E1 - Standard Fee Waiver Application

Carroll Community School

 

Code No. 537E1

 

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            

 

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 (40 %)       Temporary waiver        

 

Please check if the student or the student’s family meets the financial eligibility or is involved in one of the following programs:

 

Full waiver

            Free meals offered under the Children Nutrition Program

            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: