Fee Payment Form Elementary 20-21
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Elementary School Fee Payment Form - 2020/2021 School Year
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PLEASE READ THE IMPORTANT FOLLOWING INFORMATION:
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Only Required Fees will be waived for families who have qualified for a Waiver of School Fees. Please reference Board Policy 4:140 and Administrative Procedures 4140AP and 4140-E2 for specific information. Optional School Fees cannot be waived. Refunds are issued on a per diem basis dependent on the student's withdrawal date.
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Please list each student who attends this schoolChild 1Child 2Child 3
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Student Name
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Student I.D. Number
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Grade
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Required School FeesInstructional Materials Fee Grades KG - 5$55.00*
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Optional School FeeTechnology Protection PlanGrades KG - 1$15.00
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Technology Protection PlanGrades 2 - 5$25.00
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TOTAL DUE PER STUDENT $
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GRAND TOTAL $
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*Contact your school office for financial options. Make checks payable to: School District 59. Returned checks will be assessed a $25 fee. Unpaid required fees are subject to be sent to a collection agency.
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OFFICE USE ONLY
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School:____________________Cash__________
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Date:______________________Check__________
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Initials:____________________Check #___________
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