Technology Waiver Fee Application

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Please fill out this form to be considered for a reduced rate for technology insurance, payment plans, or for reduced costs of damages. If you have not filled out the Community Eligibility Provision (CEP): Household Survey Information and Form, you will be required to before your application is approved.

If you have not filled out the Community Eligibility Provision (CEP): Household Survey Information, you will be required to before your application is approved.

1) Visit the link below in a browser to complete the form.

2) Select APPLY FOR BENEFITS

3) Follow the prompts to complete the form.

Family Portal

Parent Name *

Parent Phone Number *

Parent Email *

Number of NW Students in Household *

Please list the names of all NW students in household *

Annual Total Family Income before taxes- Please check one that is nearest the range of income. *

At or below $17,000

$ 17,000- $32,000

$32,000 - $40,000

$40,000- $49,000

$49,000 - $57,000

$57,000- 65,000

$65,000 - $73,000

$73,000 - $82,000

$82,000- Above

Does anyone in the household currently receive state or federal assistance. *

Yes

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