Application for Fee Waiver

1
Parent/Guardian Information* This field is required.
Name
Please Select
Please Select
1
2
3
4
5
6
Number of Students
2
Contact Information* This field is required.
Address
City
Zip Code
Please enter your email
Please enter your phone number
3
Student Information* This field is required.Student #1
Name of Student
Please Select
Please Select
North Elementary School
North Grove Elementary School
South Prairie Elementary School
Southeast Elementary School
West Elementary School
Sycamore Middle School
Sycamore High School
School
Please Select
Please Select
Kindergarten
First Grade
Second Grade
Third Grade
Fouth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Grade
4
Student Information* This field is required.Student #2
Name of Student
Please Select
Please Select
North Elementary School
North Grove Elementary School
South Prairie Elementary School
Southeast Elementary School
West Elementary School
Sycamore Middle School
Sycamore High School
School
Please Select
Please Select
Kindergarten
First Grade
Second Grade
Third Grade
Fouth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Grade
5
Student Information* This field is required.Student #3
Name of Student
Please Select
Please Select
North Elementary School
North Grove Elementary School
South Prairie Elementary School
Southeast Elementary School
West Elementary School
Sycamore Middle School
Sycamore High School
School
Please Select
Please Select
Kindergarten
First Grade
Second Grade
Third Grade
Fouth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Grade
6
Student Information* This field is required.Student #4
Name of Student
Please Select
Please Select
North Elementary School
North Grove Elementary School
South Prairie Elementary School
Southeast Elementary School
West Elementary School
Sycamore Middle School
Sycamore High School
School
Please Select
Please Select
Kindergarten
First Grade
Second Grade
Third Grade
Fouth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Grade
7
Student Information* This field is required.Student #5
Name of Student
Please Select
Please Select
North Elementary School
North Grove Elementary School
South Prairie Elementary School
Southeast Elementary School
West Elementary School
Sycamore Middle School
Sycamore High School
School
Please Select
Please Select
Kindergarten
First Grade
Second Grade
Third Grade
Fouth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Grade
8
Student Information* This field is required.Student #6
Name of Student
Please Select
Please Select
North Elementary School
North Grove Elementary School
South Prairie Elementary School
Southeast Elementary School
West Elementary School
Sycamore Middle School
Sycamore High School
School
Please Select
Please Select
Kindergarten
First Grade
Second Grade
Third Grade
Fouth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Grade
9
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, TANF, 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.
10
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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11
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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