Application for Athletic Fee Waiver FY19

1

Parent/Guardian Information* This field is required

Name

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2

Contact Information* This field is required

Address

City

Zip Code

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Please enter your email

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3

Student Information* This field is requiredStudent

Name of Student

School

Grade

Sport

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4

Please select the reason for your request.* This field is required

The student(s) entered are currently receiving aid under Article IV of the Illinois Public Aid Code - Aid to Families with Dependent Children, AFDC. (Snap, Tanif, of Medicaid)

The student(s) entered are currently eligible for free meals pursuant to 105 ILCS 125/1 et sq (Income Based Application)

There are other reasons why I am unable to afford the school fee(s) assessed to the student(s) entered.

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5

Please explain why you are unable to afford the school fee(s) assessed to the student(s) entered. * This field is required

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6

By clicking submit, you are aware that supplying false information to obtain a fee waiver is a Class 4 felony (ILCS5/17-6). I attest to the statements made herein are true and correct.

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