Sharing of Information with Other Programs (Fee Waiver)
This explains what to do if you believe you have been treated unfairly. The U.S. Department of Agriculture prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the department. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found at http://www.ascr.usda.gov/complaint_filing_cust.html or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S. W., Washington D.C. 20250-9410, by fax (202) 690- 7442 or email at program.intake@usda.gov. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.
It is the policy of this CNP provider not to discriminate on the basis of race, creed, color, sex, sexual orientation, gender identity, national origin, disability, or religion in its programs, activities, or employment practices as required by the Iowa Code section 216.7and 216.9. If you have questions or grievances related to compliance with this policy by this CNP Provider, please contact the Iowa Civil Rights Commission, Grimes State Office Building, 400 E. 14th St., Des Moines, IA 50319-1004; phone number 515-281-4121, 800-457-4416; web site: https://icrc.iowa.gov/.
Federal Non-Discrimination Statement
Iowa Non-Discrimination Statement
First Name:
I certify that I am the parent/guardian of the child(ren) for whom application is being made.
Sharing of Information with Other Programs (Fee Waiver)
I understand that I will be releasing information that will show that I applied for free or reduced price school meals for my child(ren). I also understand that my rights to confidentiality will be extended to the registrar, school secretaries, fees department and those that need to know for the above selected programs, ONLY for the waiver of school fees that I have indicated and for the associated school year.
Last Name:
Grade:
First Name:
Last Name:
Grade:
First Name:
Last Name:
Grade:
Advanced Placement, Chromebook Repair and Replacement, Graduation, Textbook, and Transportation Fees
Grade:
Last Name:
First Name:
Grade:
Last Name:
First Name:
*By completing this online form, you DO NOT need to complete a paper version of the Sharing of Information with Other Programs waiver.
Your student may be eligible for free or reduced driver's education. You will need to request a waiver form from the Driver's Education company utilized for the class.
Re-type E-mail Address
Submitter E-mail Address
Signature of Parent/guardian
By checking the boxes below, your children will NOT automatically be eligible for free or reduced fees. A new Meal Eligibility Application must be completed annually. Fee adjustment is based on new eligibility for the 2022-2023 school year. The new 2022-2023 Meal Eligibility Application will be available after July 1, 2022. Please watch your email for notification after July 1st.
If your child(ren) qualifies for free or reduced price meals in the 2022-2023 school year, they may be eligible for other benefits. Listed below are specific program fees that you must select YES to if you want to authorize the Food & Nutrition Services Department to disclose your free or reduced meal eligibility status for consideration of full or partial reduction of the fees. This form must be completed each year in order for you to be eligible to have fees waived. We will no longer be back dating fees moving forward.
Fees will not be adjusted until mid-October of each school year. Fees will automatically be adjusted based on student meal eligibility and if you selected YES below. Regarding fee adjustments, please do not contact the Fees Department about the adjustments until after October 15 of the current school year. If your eligibility status is unknown, wait to pay fees until your application is reviewed and adjustments are made.
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