WAPELLO COMMUNITY SCHOOL DISTRICT
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: ____
School:
Name of parent, guardian, or legal or actual custodian:
Please check type of waiver desired:
Full Waiver ____ Partial Waiver ____ Temporary Waiver _____
Please check the student or the student's family meets the financial eligibility criteria or is involved in one of the following programs:
Full Waiver
Free meals offered under the Children Nutrition Program The Family Investment Program (FIP)
Supplemental Security Income (SSI)
Transportation assistant 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
Note: Your signature is required for the release of information regarding the student or the student's family financial eligibility for the programs checked above.