Brooklyn Permit Hardship Waiver Request Form
Organization Information (Note: only not-for-profit organizations with an annual income of $5,000,000 or less will be eligible for consideration.)
Name of Community Based Organization (Update: Fee waiver requests for the Brooklyn Borough President may be submitted for permits with activities starting February 26, 2019.) Please note this waiver program does not apply to permits that have been previously paid. *
Your answer
Tax ID *
Your answer
Contact Person's First and Last Name *
Your answer
Contact Person's Email Address *
Your answer
Contact Person's Telephone Number *
Your answer
Permit Information
Permit Number and Description *
Your answer
School-District-Borough Number Code (ex. 14K001) *
Your answer
Borough of the School Above *
Community Served by this Event *
Your answer
Age Range Served *
Your answer
Is this a new or existing program? *
Required
Total Cost of Permit *
Your answer
Permit Activity Start Date *
MM
/
DD
/
YYYY
Permit Activity End Date *
MM
/
DD
/
YYYY
Amount Requested to be Waived *
Your answer
Rationale for Waiver Request (Describe hardship) *
Your answer
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