Student Fee Reduction Request Form - School District Of Shorewood printable pdf download

Student Fee Reduction Request Form - School District Of Shorewood

STUDENT FEE REDUCTION REQUEST FORM

Date: _______________

School District of Shorewood Policy 656 – Student Fees states that

Parents/Guardians whose financial situation of their families is such that they

cannot afford to pay the established fees may request that the fees be reduced.

Print all information

Student Last Name

Student First Name

School

Grade

Parent or Guardian Name

Home Phone #

Work Phone #

Cell Phone #

Parent or Guardian Signature

Date

OTHER STUDENTS RELATED TO OR LIVING IN THE SAME HOUSEHOLD AS THE STUDENT LISTED ABOVE:

Student Name (Last, First)

Student Attends ( circle ):

Atwater / Lake Bluff / Intermediate / High School

I am requesting a fee reduction, based upon low-income status and/or other inability to pay. For purposes of

verification of eligibility for the reduction (select one of the following):

□

For the exclusive purpose of determining eligibility for the fee reduction requested above, I authorize and

grant permission to Shorewood School District staff involved in making fee decisions to access and use

the above-identified child’s eligibility status with respect to free or reduced-price meals (see important

notice, below).

□

I attest that the student is a homeless or unaccompanied youth.

□

I am

requesting a fee reduction based on other special circumstances (please attach

explanation/documentation) that I believe demonstrate an inability to pay and that I would like to

discuss with the building principal or designee.

*** Please note that yearbook fees will not be reduced. ***

Return Completed Form to School Office

-- IMPORTANT NOTICE TO PARENTS/GUARDIANS REGARDING AUTHORIZATION ON PAGE 2 --

Student Fee Reduction Request Form - School District Of Shorewood