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Evergreen Junior High School

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You are here: Home / Fee Waiver

Fee Waiver

Fee Waiver Application

  • This is your student's 9 number. I f you don't know it, that is OK.
    Parent(s)/guardian(s) will need to produce supporting documentation for each category that applies.

    *Students who receive survivor benefits do not qualify for the SSI category listed above

    Income Verification Table (Click to Enlarge): Eligibility Screen Shot 2018-19
  • Fees:

    Please check the school fee schedule and list all fees that you wish to have waived. If your student is eligible for fee waivers, all of those fees will be waived. [Please note that costs for yearbooks, class rings, letter jackets, school pictures, and similar items are not fees and will not be waived. Students may be required to pay fees for concurrent enrollment or advanced placement courses. The portion of the fees related specifically to college or post-secondary grades or credit is not subject to fee waiver.]

    If you wish to have all applicable fees waived, please check "All Fees."
  • Household Member #1

  • Wages, salaries and tips, strike benefits, unemployment comp., workers’ comp, net income from self-owned business or farm
  • Pensions, supplement, security income, retirement payments, Social Security Income (including SSI a child receives)
  • TANF payments, welfare payments, alimony, and child support payments
  • Disability benefits; cash withdrawn from savings; interest & dividends; income from estates, trusts, and investments, regular contributions from persons not living in the household; net royalties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
  • Household Member #2

  • Wages, salaries and tips, strike benefits, unemployment comp., workers’ comp, net income from self-owned business or farm
  • Pensions, supplement, security income, retirement payments, Social Security Income (including SSI a child receives)
  • TANF payments, welfare payments, alimony, and child support payments
  • Disability benefits; cash withdrawn from savings; interest & dividends; income from estates, trusts, and investments, regular contributions from persons not living in the household; net royalties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
  • Household Member #3

  • Wages, salaries and tips, strike benefits, unemployment comp., workers’ comp, net income from self-owned business or farm
  • Pensions, supplement, security income, retirement payments, Social Security Income (including SSI a child receives)
  • TANF payments, welfare payments, alimony, and child support payments
  • Disability benefits; cash withdrawn from savings; 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
  • Household Member #4

  • Wages, salaries and tips, strike benefits, unemployment comp., workers’ comp, net income from self-owned business or farm
  • Pensions, supplement, security income, retirement payments, Social Security Income (including SSI a child receives)
  • TANF payments, welfare payments, alimony, and child support payments
  • Disability benefits; cash withdrawn from savings; 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
  • Household Member #5

  • Wages, salaries and tips, strike benefits, unemployment comp., workers’ comp, net income from self-owned business or farm
  • Pensions, supplement, security income, retirement payments, Social Security Income (including SSI a child receives)
  • TANF payments, welfare payments, alimony, and child support payments
  • Disability benefits; cash withdrawn from savings; 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
  • Household Member #6

  • Wages, salaries and tips, strike benefits, unemployment comp., workers’ comp, net income from self-owned business or farm
  • Pensions, supplement, security income, retirement payments, Social Security Income (including SSI a child receives)
  • TANF payments, welfare payments, alimony, and child support payments
  • Disability benefits; cash withdrawn from savings; 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
  • Household Member #7

  • Wages, salaries and tips, strike benefits, unemployment comp., workers’ comp, net income from self-owned business or farm
  • Pensions, supplement, security income, retirement payments, Social Security Income (including SSI a child receives)
  • TANF payments, welfare payments, alimony, and child support payments
  • Disability benefits; cash withdrawn from savings; 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
  • Household Member #8

  • Wages, salaries and tips, strike benefits, unemployment comp., workers’ comp, net income from self-owned business or farm
  • Pensions, supplement, security income, retirement payments, Social Security Income (including SSI a child receives)
  • TANF payments, welfare payments, alimony, and child support payments
  • Disability benefits; cash withdrawn from savings; 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
  • Signature

    A parent/guardian must apply for a fee waiver within thirty (30) school days after the first day of school.

    A student who enters the school any time during the school year also has thirty (30) school days in which to apply for a fee waiver.

    A student whose family has a financial emergency caused by job loss, major illness or other substantial loss of income, has thirty (30) school days from the qualifying event in which to apply for a fee waiver. In this case only those fees assessed after application has been made will be waived. Fees paid previously will not be reimbursed.

    All fee payments will be suspended until the school has determined if your student is eligible for fee waivers. You will then be given a written notice of that decision. The school shall require you to prove eligibility. State law requires schools or school districts to require DOCUMENTATION of fee waiver eligibility if parent must “apply for fee waivers.” State law also requires that school districts provide alternatives in lieu of fee waivers, “to the fullest extent reasonably possible according to individual circumstances of both fee waiver applicant and school,” consistent with local board policies and/or guidelines which may include tutorial assistance to other students, assistance before or after school to teachers and other school personnel on school related matters, and general community or home service. If your student is eligible for a waiver, the school cannot require you to agree to an installment payment plan or sign an IOU in place of a waiver.
  • Parent digital signature (Please type your name)
  • MM slash DD slash YYYY
  • Documentation

    To complete the application process, parent(s)/guardian(s) shall provide income eligibility documentation in the form of income tax returns or current pay stubs demonstrating compliance with requirements consistent with state law and school district policies and/or guidelines for all qualifiers. This can be brought to West Lake during the initial registration event on August 9th from 9:00 AM to 3:00 PM, or August 10th from 12:00 PM to 6:00 PM, or during office hours after that. Also, a digital file or picture of the documentation can be uploaded to this form (below).

    In lieu of income verification, parent(s)/guardian(s) may bring supporting documents to the school for each special category that applies. For TANF (financial assistance or food stamps) attach a letter of decision covering the current period from Workforce Services. For SSI (QUALIFIED CHILD WITH DISABILITIES), attach the benefit verification letter from Social Security. For State custody or foster care, provide the “youth in custody required intake form” and/or “school enrollment letter” provided by the case worker from DCFS or Juvenile Justice Department.

    This form and all supporting documents will be destroyed after the approval process is complete.
  • Max. file size: 12 MB.
  • Max. file size: 12 MB.
  • Max. file size: 12 MB.

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Evergreen Junior High School · 3401 South 2000 East , Salt Lake City , UT 84109
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Granite School District prohibits discrimination, harassment (including sexual harassment), or retaliation on the basis of race, color, sex, pregnancy, religion, national origin, marital status, disability, sexual orientation, gender identity or any other legally protected classification in all educational programs, activities, admissions, access, treatment, or employment practices and provides equal access to scouting groups and other designated youth groups. Related inquiries and complaints may be directed to a school administrator or to David Gomez, Title IX Coordinator, 504 Coordinator, and Director of Educational Equity, (385) 646-5000. You may also contact the Office for Civil Rights, Denver, CO, (303) 844-5695. Read Policy V.C.1.

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