School Fees Waiver Application

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All information provided in connection with this application will be kept confidential. To apply for fee waiver assistance for your child(ren), please complete this form for each school your children attend. If you have more than one child in a particular school, you may list all the children in that schoo on one application.
 
 
Child Information *
 Name (First & Last)School & GradeStudent ID
Child 1
Child 2
Child 3
Child 4
Type of Waiver Desired *
Please check if the student or the student's family meets the financial eligibility criteria or is involved in one of the following programs
Please list the names of all wage earners in your household and record the gross monthly income before deductions for taxes, social security, etc. of each wage earner in the household. You are requested to provide documentation that substantiates your household income.
 Name (First & Last)Gross Monthly Income
Person 1
Person 2
Person 3
Your signature below is required for the release of information regarding the student or the student's family financial eligibility for the program checked on this form.  
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Nondiscrimination Statement
The Sioux City Community School District is an equal opportunity/affirmative action employer. It is an unfair or discriminatory practice for any educational institution to discriminate on the basis of race, creed, color, sex, sexual orientation, gender identity, national origin, religion, age (for employment), disability, socioeconomic status (for programs), marital status (for programs), or veteran status in its educational programs and its employment practices.  Inquiries or grievances may be directed to Jen Gomez, Director of Student Services & Equity Education at 627 4th Street, Sioux City, IA 51101, (712) 279-6075, gomezj2@live.siouxcityschools.com.