School Fees Resolution Form

SCHOOL FEES RESOLUTION FORM

This form is submitted to request formal resolution of school-assessed fees, charges, holds, or fines. Submission of this form authorizes the school to verify information provided and to take administrative action consistent with school policy. Incomplete forms may delay processing.

Student Information

Student Name:    Student ID:

Date of Birth:    Grade/Program:

Fee(s) Under Dispute or Resolution

List each fee, amount, and date assessed. Attach additional pages if necessary.

Requested Resolution

Select one or more remedies requested. The school will evaluate and respond in writing.

Proposed Payment Plan (if applicable)

Financial Hardship & Supporting Information

Indicate circumstances supporting the requested resolution. Provide documentation where indicated.

Documentation Provided

Check all documents attached with this form.

Certifications, Authorizations & Notices

By signing below I certify that the information provided on this form and in attached documentation is true and correct to the best of my knowledge. I understand that knowingly submitting false information to obtain a fee waiver, reduction, or payment accommodation may result in administrative and legal consequences, including collection action and revocation of relief.

I authorize the school to verify income, enrollment, and other necessary records with third parties as needed to evaluate this request. I understand that approval of any requested remedy is discretionary and subject to applicable school policies and availability of funds. If a payment plan is approved, failure to comply with the terms may result in reinstatement of the full balance and administrative holds.

Contact Information for Applicant

Administrative Use Only

Processing staff must complete this section. Determinations are based on documentation and applicable policy.

Applicant Certification and Signature

I certify that the statements made on this form are true and correct. I understand that submission of this form does not guarantee relief. I further understand that if relief is granted, the school may require compliance with the terms of any payment arrangement.

Sign Now