FP(EXHIBIT) - STUDENT FEES, FINES, AND CHARGES

APPLICATION FOR WAIVER OF FEES

I, , request a waiver of fees for

name of student

_____________________________________due to the following reason(s):

I, , understand that the District will

name of parent/guardian

waive fees only if a determination of eligibility, based on District guidelines, is made.

Signature of parent/guardianDate

Approved

Not approved

Reason(s):

Signature of principalDate

Richardson ISD

FP(EXHIBIT)-X

LDU-20-93

DATE ISSUED: 9/20/1993