Fee Waiver Application - Hinsdale South High School

Fee Waiver applications will be processed from July 16th thru August 6th in the Main Office, Room 201 from 7 a.m. to 2 p.m. Questions? Call 630·468·4216. INSTRUCTIONS FOR APPLYING - COMPLETE ONE APPLICATION PER HOUSEHOLD PER SCHOOL DISTRICTIF YOUR HOUSEHOLD RECEIVES SNAP OR TANF BENEFITS, FOLLOW THESE INSTRUCTIONS AND RETURN THE COMPLETED FORM TO YOUR SCHOOL:Part 1: List all household members, school and grade for each st~dent, a~d a SNAP or TANF case number for any household rr·ember including adults receiving suchbenefits, (Attach another sheet of paper If necessary,) ,Part 2: Skip this partPart 3: Skip this partPart 4: Sign the form,(The last four digits of a Social Secur'ty NLlrlber are not necessary,)Part 5, 6, 7: Contact Information: Children's Racial and Ethnic Identities, and All ,'

APPLICATION FOR FREE MILKlM::ALAND REDUCED·PRICE M::ALS-Co~plete One Application Per Household Der School District Instructions on back.All Household Member sNAME(S) OF STUDENTS(last, First, MI)o Homeless 0 Migrant Head Start2. Homeless, Migrant, Runaway, or Head Start (Categorically eligible)ISNAP OR TANF CASE NUMBER Skip to Part 4~~YOUChect!; if Check IfSTUDENT 10 NUMBER(s) ~;s: ,a S~F.? or ~At-~F case numDer. At least ore SNAPfTAr.,,;;:: mustIDe p~ovlded belowNOIncomeFo!>terChild"1I I . I . : I DOIIII • I j . I I . I D 0I. I . .0 0I I . I . I Ic:J 0I i I I i DIDII •Ij . I I I 0 0I• A foster child is the legal responsibility of a welfare agency or court3. Total Household Gross Income (before deductions) You must tell us how much and how often.A. ! GROSS INCOME AND HOW OFTEN IT WAS RECEIVED (Example: $100/rT'onthl 5100 itwice a ",anthl $10D/every olherwee,