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