Registration Fee Waiver Application – Special Education Student

Complete this form and provide the verification documentation required.

Your application will not be considered without proper verification documentation.

Registration Fee Waiver Application – Special Education

Student Name(Required)

First Last

Student Birth Date(Required)

Name of Parent Requesting Waiver(Required)

First Last

Phone Number(Required)

Email Address (decision will be sent to the email address you provide here)(Required)

Enter Email Confirm Email

Eligibility

Please check the eligibility that applies (only 1 is needed).(Required)

1. Family receives: TANF, FEP, or SNAP.*

2. Preschool student receives SSI for a qualified disability.

3. Student qualifies for McKinney-Vento.

4. Student is in Foster Care (under Utah or local governmental supervision).

5. Student is in State Custody.

6. Student is eligible based on family/household income verification.

7. Other (see below)

*TANF (Temporary Assistance for Needy Families, FEP (Family Employment Program), SNAP (Supplemental Nutrition Assistance Program, SSI (Supplemental Security Income)

If none of the above apply but you wish to apply for a fee waiver because of other extenuating circumstances, please state the reason(s) for the request in the box below and provide applicable verification documentation:

You must include the following verification:

Benefit verification from the Utah Department of Workforce Services for the period for which the fee waiver is sought which may be in the form of an electronic screenshot of eligibility determination or status.(Required)

Max. file size: 20 MB.

Benefit verification documents from the Social Security Administration.(Required)

Max. file size: 20 MB.

Verified through the district McKinney-Vento Liaison.(Required)

Max. file size: 20 MB.

The youth in care required intake form and school enrollment letter, provided by a case worker from the Utah Division of Child and Family Services or the Utah Juvenile Justice Department.(Required)

Max. file size: 20 MB.

Family income verification in the form of pay stubs or tax returns.(Required)

Max. file size: 20 MB.

Signature(Required)