Textbook Waiver Form 2006-07
by Barb Williamson
June 01, 2006
______________________________________, the parent/guardian of the following child(ren):
Parent/Guardian
Name Grade
______________________________________________ ______________
______________________________________________ _______________
______________________________________________ _______________
______________________________________________ _______________
requests that the payment of the textbook fee for the 2006-2007 school year be waived due to the following extenuating circumstance: (Please be specific)
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________ ________________
Parent/Guardian Date
------------------------------------------------------------------------------------------------------------------
Waiver is granted ___________________________________ __________________based on income School Official Date
eligibility guidelines and circumstance listed above
Waiver is NOT granted __________________________________ __________________
based on income School Official Date
eligibility guidelines and/or circumstance listed above
See the building administrator
to work out a suitable payment plan.
