2021-2022 USD 261 Enrollment

SECTION I
HOUSEHOLD ECONOMIC SUPPORT FORM
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The information given will be used to determine whether the school district is eligible to receive specific state and federal funding, and individual data may be used to provide fee waivers and/or other services for individual students. The information you provide will remain strictly confidential. By filling out this form, you are helping to ensure that the school district receives the funding to which it is entitled and that we can continue to support district families.

 (Numbers only - Special Characters such as $ or decimals(.) are not allowed)

List all students, school, grade, and date of birth below.

I certify (promise) that all information on this form is true and that all income is reported. I understand that the school will receive federal and state funding based on the information provided. I understand that school officials may verify (check) the information.

Parent/Guardian Name:     Date:     Phone: 

SECTION II
CONSENT FOR DISCLOSURE
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With your permission, information given on the Household Economic Survey can be shared with other USD 261 district departments to save you time and effort. The information shared will be used to determine if the students listed on the previous page are eligible to receive waivers for various school district fees. If you would like the information shared, you must check “Yes” below and which fees you would like to receive waivers for (if approved).

Yes, I DO want school officials to use the information provided above to determine eligibility to receive fee waivers for the following school fees I have checked below.

         You must select which fees you would like waived if approved!

Parent/Guardian Name:     Date:     Address: 

If you click "submit" and do not get a THANK YOU screen the form did not successfully process, please try again or call Information Services at 316-554-2203.

This institution is an equal opportunity provider.