Athletic Fee Hardship Waiver Application
Athletic Fee Hardship Waiver Application The purpose of the athletic fee is to provide revenue to maintain and operate athletic programs, which exceeds $2,000,000 per year, for 7th-8th grade and high school students. These fees collected will help defray the expenses of operating the DVUSD athletic programs. The athletic fee is in compliance with legislation passed in 1995, A.R.S. 15-342.24, enabling schools to assess reasonable fees for optional extra-curricular activities and programs. The Athletic Fee Waiver form must be submitted by the end of the second week of practice.
Please print: School: _________________________________________ Sport: ___________________ Level: __________ Student’s Name: _______________________________ Parent(s) Name: _____________________________ Parent’s Contact: ___________________________________________ and ___________________________ E-mail address
Phone #
To qualify for an athletic fee waiver, a student must submit an athletic clearance packet and qualify based upon one of the following: Please check below: _____ An approved McKinney-Vento eligibility status _____ An approved free and reduced meal application _____ A free and reduced meal application has not been filed or has been denied, and a current hardship exists. Please attach an explanation for your request. Signature of this form indicates household consent to disclose student free and reduced price eligibility information to the school administration.*
__________________________
_________________________
Signature of Parent or Guardian
Date
OFFICE USE ONLY _____ Approve _____ Deny
____________________________________ Signature of Principal /Designee
___________________________ Date
*Disclosure means revealing or using individual children’s program eligibility information that is obtained through the certification eligibility process for a purpose other than the purpose for which the information was obtained. Disclosure includes, but is not limited to, access, release, or transfer of personal data about children by means of print, tape, microfilm, microfiche, electronic communication or any other means. It includes eligibility information obtained through the household application or through Direct Certification and whether the children are eligible for free meals or reduced-price meals. 6/03/16
Please print: School: _________________________________________ Sport: ___________________ Level: __________ Student’s Name: _______________________________ Parent(s) Name: _____________________________ Parent’s Contact: ___________________________________________ and ___________________________ E-mail address
Phone #
To qualify for an athletic fee waiver, a student must submit an athletic clearance packet and qualify based upon one of the following: Please check below: _____ An approved McKinney-Vento eligibility status _____ An approved free and reduced meal application _____ A free and reduced meal application has not been filed or has been denied, and a current hardship exists. Please attach an explanation for your request. Signature of this form indicates household consent to disclose student free and reduced price eligibility information to the school administration.*
__________________________
_________________________
Signature of Parent or Guardian
Date
OFFICE USE ONLY _____ Approve _____ Deny
____________________________________ Signature of Principal /Designee
___________________________ Date
*Disclosure means revealing or using individual children’s program eligibility information that is obtained through the certification eligibility process for a purpose other than the purpose for which the information was obtained. Disclosure includes, but is not limited to, access, release, or transfer of personal data about children by means of print, tape, microfilm, microfiche, electronic communication or any other means. It includes eligibility information obtained through the household application or through Direct Certification and whether the children are eligible for free meals or reduced-price meals. 6/03/16
