Student Fee Reduction Request Form - School District Of Shorewood (Page 2 of 2) in pdf

Student Fee Reduction Request Form - School District Of Shorewood Page 2

IMPORTANT NOTICE TO PARENTS/GUARDIANS REGARDING AUTHORIZATION

TO ACCESS AND USE A STUDENT’S FREE AND REDUCED-PRICE MEAL ELIGIBILITY STATUS

Authorizing District staff to access a student’s eligibility status with regard to federal free or reduced-price

meal programs is one way that a parent or guardian may demonstrate eligibility for the fee reductions. You

are not required to authorize this access. If you choose not to authorize this access, your decision will not

affect the student’s eligibility to participate in the District’s school meal program or any other school program

or activity. If you choose to authorize this access:

●

Only school district personnel directly involved in making the fee reduction eligibility determination will

access the student’s school meal eligibility status.

●

The only information that will be accessed in connection with making fee reduction decisions will be the

District’s records indicating that the student is either eligible, or not eligible, for free meals or for

reduced-price meals at school.

●

The student’s free or reduced-price meal eligibility status will be used only to determine the student’s

eligibility for the fee reduction(s) you are requesting, and will not be disclosed to any other programs or

entities.

FOR OFFICE USE ONLY

School

School Year of Application

Student Last Name

Student First Name

□

FEE REDUCTION APPROVED:

Percent of Fees Reduced:

□

FEE REDUCTION DENIED:

Reason:

Authorized Signature

Title

Date

Student Fee Reduction Request Form - School District Of Shorewood Page 2