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Consent to Share Education Benefits Form

Required

Students who are eligible to receive federal and state educational benefits are eligible to receive benefits such as reduced fees for athletics/activities, community education, and other student expenses.

If you agree to share this information, your student’s eligibility status will only be shared with district staff on a need-to-know basis for the purposes described in this form. Your agreement to share this information is completely voluntary. Not all benefits and programs will be available to students at every school and every grade level.
Please Complete your student's information. required
Student Name
Grade
School Name
If you have more than more than one student fill in the slots below:
Student Name
Grade
School Name
*Optional
Student Name
Grade
School Name
*Optional
Student Name
Grade
School Name
Your student’s eligibility will be shared with select district staff on a need-to-know, confidential basis for the purposes you select by checking the boxes below:required
Must contain a date in MM/DD/YYYY format
Name of Parent/Guardianrequired
First Name
Last Name