Consent to Share Program Eligibility Information 2020-2021
If you receive Basic Food, Temporary Assistance for Needy Families (TANF), Food Distribution on Indian Reservations (FDPIR), or have been Directly Certified as eligible for free meals you may be eligible for decreased fees to participate in other school programs. Submitting/not submitting this form will not affect your child’s eligibility for free meals.

You must check the box for each program you would like to participate in and sign the form to allow your eligibility status to be shared for other program benefits.

Please contact Mount Vernon High School with any questions at 360.428.6100.

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Email *
The parent/guardian will allow student(s) to have fee reductions and/or waivers by checking boxes below. *
Required
List FULL name of students below that you consent to share income eligibility to qualify for the above programs. *
By typing your name as parent/guardian you agree to having this information shared. *
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Phone number (to contact you if we have questions)
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