School Fee Waiver Application
• NO Fees may be charged for activities during the regular school day in grades K-6. Fees for activities
held outside of the regular school day are subject to fee waivers.
• Fees shall be suspended while the fee waiver is under consideration and during the appeal of a
denial of a fee waiver is in process.
• Upon approval, all school fees shall be waived
. Parent/student cannot be required to complete
service,
agree to an installment payment plan, or sign an IOU in place of a waiver.
• For additional information read “School Fees Notice Grades 7-12” or “School Fee Notice Grades K-6”.
Student Information:
Name of student:
Student #:
Address:
School:
Grade lev el:
Name of parent:
Phone number:
Basis for Fee Waiver:
Please check the eligibility that applies: (only 1 is needed) Verification to submit: *
•
1. Family receives -
Temporary Assistance for Needy Families (TANF),
Family Employment Program (FEP), or
Supplemental Nutrition Assistance Program (SNAP)
benefit verification from the Utah Department of
Workforce Services for the period for which the fee waiver
is sought which may be in the form of an electronic
screenshot of eligibility determination or status.
2. Student receives Supplemental Security Income (SSI) for a
qualified disability (fees waived for student with disability only
benefit verification documents from the Social Security
Administration.
•
3. Student qualifies for McKinney-Vento. verified through the district or charters McKinney-Vento
Liaison.
•
• 4. Student is in Foster Care (under Utah or local governmental
supervision)
5. Student is in State Custody
the youth in care required intake form and school
enrollment letter, provided by a case worker from the Utah
Division of Child and Family Services or the Utah Juvenile
Justice Department.
6. Student is eligible based on family/household income
verification. Provide summary of income on page 2.
• family income verification in the form of pay stubs or tax
returns.
If none of the above apply but you wish to apply for fee waivers because of other extenuating circumstances, please state the reason(s) for
the request in the box below:
Submit completed application and verification documents* to the school's Principal/School Director or School Fee
Administrator .
I HEREBY CERTIFY THAT THE INFORMATION AND ATTACHED DOCUMENTATION I HAVE PROVIDED IS TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.
Date: Parent's Signature:
Revised February 2024
ADA Compliant 4/19/2024
COMPLETE THIS PAGE ONLY IF OPTION #6 WAS SELECTED UNDER THE BASIS FOR FEE WAIVER SECTION
INCOME VERIFICATION FOR ALL HOUSEHOLD MEMBERS:
Household income is determined by adding all household income from all sources and then comparing it to the number of people in the household.
Definition of a household: a group of related or unrelated individuals who are not residents of an institution or boarding house but who are living as one
economic unit. This means they generally reside in the same house and share expenses such as rent, utilities and food.
List all MONTHLY income before deductions in the appropriate column(s).
Name:
LastFirst
Earnings from Work
(before deductions
Pension/Retirement
Social Security
Welfare, Alimony, Child
Support, Other Income
Total Monthly Income
Per Person
1 $ $ $ $
2 $ $ $ $
3 $ $ $ $
4
$ $ $ $
EXAMPLES OF INCOME:
Earnings from Work
Wages, salaries and tips,
unemployment comp.,
workers’ comp, net income
from self-owned business
or farm
Pension/Retirement, Social Security
Pensions, Social Security income,
retirement payments, Social Security
Income (including SSI a child
receives)
Assistance, Alimony,
Child Support
SNAP, FEP, TANF payments,
welfare payments,
alimony, and child support
payments
Other Income
Disability benefits; interest & dividends;
income from estates, trusts, and investments,
regular contributions from persons not living
in the household; net royalties and annuities;
net rental income; any other income
INCOME ELIGIBILITY GUIDELINES
For School Year:
July 1, 2024 - June 30, 2025
Household Size Yearly Monthly Twice Per Month Every Two Weeks Weekly
1
19,578
1,632
816 753
3
77
2
26,572 2,215
1,108
1,022
511
3
33,566 2,798
1,3
99
1,291 646
4
40,560 3,380
1,6
90
1,5
60
780
5
47,554 3,963
1,9
82
1,829
915
6
54,548 4,546 2,273
2,0
98
1,049
7
61,542 5,129 2,565
2,367
1,184
8
68,536 5,712 2,856
2,636
1,318
For each additional
family member, add:
6,994 583 292 269 135
Revised February 2024
Page 2
Household size: Total Household Monthly Income: $
Fee Waiver Decision and Appeal Form
To the parent or legal guardian of:
Your application for fee waiver has been:
Approved - ALL fees will be waived for the school year.
Denied - for the following reason:
Your child does not qualify under any of the eligible categories.
You have not provided the documentation necessary to determine if your child qualifies for fee
waivers.
Other:
Signed:
(Signature of school employee)
Date:
Parental Appeal Rights:
IF YOU DISAGREE WITH THIS DECISION, YOU HAVE THE RIGHT TO APPEAL. To appeal, send a letter (or the
Notice of Appeal form printed at the bottom of this page) to the principal/charter school director, explaining why
you disagree with this decision. Include your name, your child’s name, and the date. YOU MUST MAIL OR HAND-
DELIVER YOUR APPEAL WITHIN TEN SCHOOL DAYS OF RECEIVING THIS NOTICE. Keep a copy of the appeal for your
records. A school representative will contact you within two weeks after receiving your appeal and schedule a meeting
to discuss your concerns. You will also be given a copy of the districts’/charter schools’ Fee Waiver Appeals Policy
containing a complete statement of policies and procedures for appeals.
ALL REQUIREMENTS FOR PAYMENT OF FEES WILL BE SUSPENDED UNTIL THE FINAL DECISION IS MADE
REGARDING YOUR APPEAL.
Notice of Appeal:
I, wish to appeal the decision regarding my application for
school fee waivers for the following reasons:
My child’s name is:
Please schedule a meeting to discuss this appeal. I understand that all fees will be suspended until a final decision has
been reached, and that my child will be able to participate fully in all school activities during that time on the same
basis as if the fees had been paid.
(Signature of person submitting the appeal)
Date:
School Contact: Phone Number:
Revised February 2024
ADA Compliant 2/21/2024
Service Agreement Form
Utah law states that an LEA may allow a student to perform service in lieu of a fee “to ensure that no student is
denied the opportunity to participate in a class or school-sponsored or supported activity because of an inability to
pay a fee.” If offered, a student may choose to perform service in lieu of a fee but a school district cannot require
a student to perform service in lieu of a fee waiver. If your student chooses to perform service, there are options
from which to choose to complete the service. Service options may include:
• Service at the school, such as tutorial assistance to other students, or service outside of regular school hours as
a student aide to school staff;
• Service in the community such as at a nursing home or hospital; or
• When special needs require, service in the home.
(Student’s name)
agrees to complete hours of service
(brief description)
To be completed before:
(Date)
This will satisfy the student’s fee obligation of $
All services will be credited at the rate of $ per hour. Once completed, the student’s school fees will be
waived.
SIGNATURES:
Student: Date:
Parent/Guardian: Date:
School Administrator: Date:
The school must ensure that a service assignment is appropriate to the age of the student, physical condition of the
student, and maturity of the student. The assignment must also be consistent with state and federal laws, including
the Federal Fair Labor Standards Act. This requires that the service must be performed 1) within a reasonable period
of time, 2) each hour of service is credited at an amount at least equal to the current minimum wage, and 3) service
hours worked per day and week are limited according to the student’s age.
For example, if a student is assessed $100 for school fees and the school policy is based upon a $10 per hour
service credit, then the student may be asked to perform up to 10 hours of service.
Service assignments must be conducted in such a way that students are not subjected to embarrassment, ridicule,
or humiliation, and must not provide direct private benefit to school employees or their families. In addition, service
assignments must avoid excessive burdens on students and families and give proper consideration to a student’s
educational and transportation needs and other responsibilities.
Revised July 2023
ADA Compliant 2/
20/2024
If circumstances arise which make it too difficult for a student to complete a service assignment, notify
the school principal immediately to determine what adjustments should be made.
Service students will not be considered to be employees of those for whom they provide the service, and no money
will be paid to the students or to the school in return for service. Regular employees who work in places where
students perform services may not be replaced, nor may their hours be reduced, as a result of the students’ service
activities. Service is intended to supplement existing services, not replace that which is already being done by others.
Verification of Service:
Service Location: Service Performed:
Supervisor: Hours:
Starting Date: Ending Date:
Service Location: Service Performed:
Supervisor: Hours:
Starting Date: Ending Date:
(Student’s name)
has completed all service hours as stated above, and fullfilled all agreed upon
service hours to the fullest extent reasonably possible according to individual circumstances of both the student and
the school.
Parent/Guardian: Date:
Supervisor: Date:
I hav
e reviewed the service provided and verified with the Supervisor that all service was completed as stated above
to the fullest extent reasonably possible according to individual circumstances of both the student and the school.
Therefore, as agreed, all student fees have been waived.
School Administrator: Date:
Email:
Phone:
Website:
Page 2
School Fees Notice for Families of
Students in Grades K-6
The Utah Constitution prohibits the charging of fees in elementary schools.
If a child is in kindergarten through grade six, they cannot be charged for textbooks, classroom equipment or
supplies, musical instruments, field trips, assemblies, snacks (other than food provided through the School Lunch
Program), or for anything else that takes place or is used during the regular school day.
Fees may only be charged for programs offered before or after school, or during school vacations. Fees may also
be charged for a student that is in grade six and attends a school that includes one or more 7-12 grades, if the school
follows a secondary model of delivering education to the school’s grade six students.
Utah law requires schools that charge fees, to ensure that a fee waiver or other provisions in lieu of a fee waiver is
available to any student whose parents are unable to pay a fee.
Fee Waivers
A fee waiver is a full release from the requirement to
pay a fee. If a student is eligible for fee waivers, all fall fees ees
must be wmust be waivaiveded. If it is not specifically addressed in state
law, a school must waive all fees, including any where a
student’s participation is optional. This means that those
students who are eligible for a fee waiver can participate
in any school class or activity free of charge.
A student is eligible for a waiver if:
• their family receives TANF funding or SNAP
(food stamps or state Family Employment
Program, Supplemental Nutrition Assistance
Program);
• the student receives SSI (Supplemental Security
Income);
• the student is designated McKinney-Vento;
• the student is in foster care;
• the student is in state custody; or
• the student is eligible based on family/household
income (the levels match those of free lunch
eligibility).
* A student may also be eligible for fee waivers if they do
not meet any of these standards but are still unable to
pay a fee. Please see the local school or district policy
for more information.
If a student wishes to apply for fee waivers, they will be
asked to provide documentation of fee waiver eligibility
as part of the application process.
To apply for a fee waiver, a student may submit the
“Fee Waiver Application (Grades K-6)”. A copy of the
application is included with this notice and additional
copies may be obtained from the school office, or
the state school fees website listed at the end of this
document. Once the documents have been submitted to
the school, the fee requirement will be suspended until
a final decision has been reached about the student’s
eligibility for fee waivers.
If the application is denied, the school will send a
“Decision and Appeal Form”. The Form will explain why
the application was denied and how to appeal the
decision. Remember to always keep a copy. If an appeal
for a denial of fee waivers is submitted, all fees will not
need to be paid until the appeal is decided.
If a student wishes to purchase school pictures,
yearbooks, or similar items through the school, those
costs are not fees and will not be waived. Also, if a
student loses or damages school property, the costs
of replacement or repair are not fees and need not be
waived.
RevisedRevised February 2024
ADA Compliant 2/20/2024
Page 1
Donations, Confidentiality, and Enforcement of Fees
School funds are limited, and a school may need help in addition to fees. As a result, the school may ask for tax-
deductible donations of school supplies, equipment, or money, but the school cannot require donations.
A students name is confidential and cannot be disclosed to anyone lacking both a right and a need to know the
information, regardless of whether a student has paid fees, donations, and contributions or not, or has applied
for, received, or been denied waivers. The school may, however, with the consent of the donor, give appropriate
recognition to any person or organization making a major donation or contribution to the school.
The school and school staff cannot withhold, reduce, or enhance grades or credit, or withhold grades, class schedules,
credit, report cards, transcripts, or diplomas to enforce the payment of fees.
For further information, contact:
Local school:
Name: Phone:
Email: Website:
District/Charter School Fees Contact:
Name: Phone:
Email: Website:
Revised February 2024
Page 2
School Fees Notice for Families of
Students in Grades 7-12
Utah law permits schools to charge fees in grades seven through twelve.
A student may be charged fees for participation in school classes, activities and programs. A student cannot be
requested or required to pay any fee unless that request or requirement has been approved by the local Board of
Education and included in the school or district fee schedule.
Utah law requires schools that charge fees to ensure that a fee waiver or other provisions in lieu of a fee waiver is
available to any student whose families are unable to pay a fee.
Fee Definition
A fee is defined as something of monetary value that is requested or required by a school for a student to be able to
participate in an activity, class, or program that is provided, sponsored, or supported by a school, charter school, or
district. This request or requirement can also be implied. Meaning that if something is not required for participation,
but there is still an expectation for the student to have that item, it becomes a school fee. Below are some examples
of fees:
• Registration fees • Costs of class or team trips (including • After-school program
room, board, and meals)
fees
• Truancy fines
• Entrance fees for school concerts or
games
• Instrument rentals
• Participation fees
• Football summer clinic costs
Charges for class rings, yearbooks, school pictures, letter jackets, and similar items are not fees and need not be
waived. Also, if a student loses or damages school property, the costs of replacement or repair are not fees and need
not be waived.
Students may be required to pay fees for concurrent enrollment courses or advanced placement exams. The portion
of the fees related specifically to college or post-secondary grades or credit is not subject to fee waiver. However, the
College Board offers a reduction in these costs for those who are eligible.
Fee Waivers
A student is eligible for a waiver if:
• their family receives TANF funding or SNAP (food
stamps or
state Family Employment Program,
Supplemental Nutrition Assistance Program);
• the student receives SSI (Supplemental Security
Income);
• the student is designated McKinney-Vento;
• the student is in foster care;
• the student is in state custody; or
• the student is eligible based on family/household
income (the levels match those of free lunch
eligibility).
A fee waiver is a full release from the requirement to
pay a fee. If a student is eligible for fee waivers, all fall fees ees
must be wmust be waivaiveded. If it is not specifically addressed in state
law, a school must waive all fees, including anywhere a
student’s participation is optional. This means that those
students who are eligible for a fee waiver can participate
in any school class or activity free of charge.
* A student may also be eligible for fee waivers if
they do not meet any of these standards but are
still unable to pay a fee. Please see the local school
or district policy for more information.
Revised March 2024
ADA Compliant 2
/20
/2024
Page 1
Fee Waivers continued
If a student wishes to apply for fee waivers, they will be
Once the documents have been submitted to the school,
asked to provide documentation of fee waiver eligibility
the fee requirement will be suspended until a final
as part of the application process.
decision has been reached about the student’s eligibility
for fee waivers.
To apply for a fee waiver, a student may submit the
“Fee Waiver Application (Grades 7-12)”. A copy of the
If the application is denied, the school will send a
application is included with this notice and additional
“Decision and Appeal Form”. The form will explain why
copies may be obtained from the school office, or
the application was denied and how to appeal the
the state school fees website listed at the end of this
decision.
document.
Remember to always keep a copy. If an appeal for a
denial of fee waivers is submitted, all fees will not need to
be paid until the appeal is decided.
Donations, Confidentiality, and Enforcement of Fees
School funds are limited, and a school may need help in addition to fees. As a result, the school may ask for tax-
deductible donations of school supplies, equipment, or money, but the school cannot require donations.
A students name is confidential and cannot be disclosed to anyone lacking both a right and a need to know the
information, regardless of whether a student has paid fees, donations, and contributions or not, or has applied
for, received, or been denied waivers. The school may, however, with the consent of the donor, give appropriate
recognition to any person or organization making a major donation or contribution to the school.
The school and school staff cannot withhold, reduce, or enhance grades or credit, or withhold grades, class schedules,
credit, report cards, transcripts, or diplomas to enforce the payment of fees.
For further information, contact:
Local school:
Name: Phone:
Email: Website:
District/Charter School Fees Contact:
Name: Phone:
Email: Website:
Revised February 2024
Page
2
School Fees Notice to Grades 7-12