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 free or reduced textbook and other 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 textbook and 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 textbook and 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 textbook and other school fees for my student(s).
I certify that I am the parent/guardian of the child(ren) for whom application is being made.
Printed Name of Parent/Guardian
Signature of Parent/Guardian
First Reading Approved 3/12/2018 Second Reading Approved 4/9/2018