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___________________         

Attendance Center/School:________________________________________________________                                                     

Name of parent, guardian: ________________________________________________________                                                    
  or legal or actual custodian

Please check type of waiver desired:

  _______Full waiver    ______Partial waiver    _____Temporary waiver     

Please check if 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 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:

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.

Reviewed: 3/11/24

The board recognizes that while certain fees charged students are appropriate and authorized, certain students and their families are not financially able to pay the fees.  The school district will grant either full waivers, partial waivers or temporary waivers depending upon the circumstances and the student or student's parents' ability to meet the financial criteria.

            A.        Waivers -

1.         Full Waivers - a student will be granted a full waiver of fees charged by the school district if the student or student's parents meet the financial eligibility criteria for free meals under the Child Nutrition program, Family Investment Program, Supplemental Security Income guidelines, or transportation assistance under open enrollment.  Students in foster care are also eligible for full waivers.

2.         Partial Waivers - a student will be granted a partial waiver of fees charged by the school district if the student or the student's parents meet the financial eligibility criteria for reduced price meals offered under the Child Nutrition program. 

3.         Temporary Waivers - a student may be eligible for a temporary waiver of fees charged by the district in the event the student's parents are facing financial difficulty.  Temporary waivers may be applied for at any time throughout the school year and shall not extend beyond the end of the school year.

B.         Application - Parents or students eligible for a fee waiver shall make an application on the form provided by the school district.  Applications may be made at any time but must be renewed annually.

C.         Confidentiality - The school district will treat the application and application process as any other student record and student confidentiality and access provisions will be followed.

D.        Appeals - Denials of a waiver may be appealed to the (school districts need to fill in their own appeal process).

E.         Fines or charges assessed for damage or loss to school property are not fees and will not be waived.

F.         Notice - the school district will annually notify parents and students of the waiver.  The following information will be included in registration materials and printed in the (parent handbook, student handbook):

Students whose families meet the income guidelines for free and reduced price lunch, the Family Investment Program (FIP), Supplemental Security Income (SSI), transportation assistance under open enrollment, or who are in foster care are eligible to have their student fees waived or partially waived.  Students whose families are experiencing a temporary financial difficulty may be eligible for a temporary waiver of student fees.  Parents or students who believe they may qualify for temporary financial hardship should contact the (principal, secretary, etc.) at (registration time, by (date), etc.) for a waiver form.  This waiver does not carry over from year to year and must be completed annually.

Legal Reference: Iowa Code: § 256.7; § 279.8; § 280.10; § 280.11; § 282.6; § 285.1; § 301.1; 281 I.A.C. 18.2

Cross Reference:           501.16  Homeless Children and Youth

Reviewed 03/11/2024