Parental Consent Survey SY 23-24

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Student's who qualify for free or reduced price meals may qualify for reduced fees.

The Parental Consent Survey is for the current school year and is specific for fee's not related to Nutrition Services.

Please note, the survey takes at least 24-36 business hours for benefits to process.

This survey is not applicable to elementary students.

I have submitted a Benefits Application (free and reduced price meal application) on Skyward. *

Yes

Student's Name: *

Parent's Email Address: *

Parent's Phone Number: *

Select your child's school: *

Cheney Middle School

Westwood Middle School

Cheney High School

Three Springs High School

WIN

Please select which programs you consent free or reduced price meal information to be shared. *

Associated Student Body (ASB) Fees

Tests/Exams

Running Start

College Application Fees

Club/Extra Curricular

Select All

Required

I understand my child must have a qualifying Free and Reduced application (CHS) or Family Income Survey (CMS,WMS) on file to qualify for extended reduced fee's provided by the Parental Consent Survey. *

I understand.

I certify (promise) that all information on this survey is true and I understand that this information is given in connection with the receipt of federal funds and that school officals may verify (check) the information. I am aware that if I purposely give false information, my children may lose benefits, and I may be prosecuted under applicable State and Federal laws. *

Yes, I agree to the statement above.

By typing my name, I acknowledge that I am the Parent/Guardian of the student listed above and consent free and reduced price meal information be shared with the Cheney School District programs selected above. Please sign your name. *

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