(FOR USE IN SCHOOLS SERVING ANY GRADE, K-6)
Note: as used in this form, "we" means staff members and other persons who assist staff
members in school-sponsored activities.
I, ____________________________________, Principal of the __________________________
School in the _________________________________ School District, hereby certify that:
A. DOCUMENTS ATTACHED TO THIS CERTIFICATION FORM
I have attached copies of the following documents, which we provided to parents and guardians:
1. The School Fees Notice for Families of Students in Kindergarten through Sixth Grades;
2. If fees were permitted for programs operating outside of the regular school day:
a. the fee schedule approved by the Board of Education for this school; and
b. the Fee Waiver Application (Grades K-6).
B. ASSURANCES (GENERAL)
1. I have read this Elementary School Certification of Compliance, the School Fees Notice for
Families of Students in Kindergarten through Sixth Grades, the permanent injunction issued
by the Third District Court, the school fees policy for my school district, and the school fee
schedule approved by the board of education.
2. Copies of all of the documents listed in item B.1. have been kept in the faculty lounge.
3. I gave a copy of the School Fees Notice for Families of Students in Kindergarten through
Sixth Grades to each member of the faculty.
4. I discussed school fees and fee waivers, the definitions and limitations governing school fees
set forth in the Permanent Injunction, this school's fee schedule, if any, as approved by the
Board of Education, and the terms of this Certification of Compliance Form with my staff
and advised them that they must fully comply with all laws and policies governing school
fees and fee waivers, and that no fee may be charged which is not listed on the boardapproved
5. I advised the staff that no fees may be charged in connection with any class, program, or
activity that occurs during the regular school day in grades K-6.
6. Information submitted in connection with fee waiver applications, the names of persons who
have or have not paid fees, donations, or contributions, and the names of persons who have
applied for, received, or been denied waivers, are confidential. We do not make any
disclosure, without permission, of any of those names to any person lacking both the right
and the need to know, and from posting any list accessible to unauthorized persons regarding
the payment or non-payment of any fee, contribution, or donation by any student, parent, or
guardian. However, appropriate recognition may be given to any person or organization
which makes a major donation or contribution.
7. We do not permit the withholding, enhancement, or reduction of grades, or the withholding of
report cards or other school records, to enforce the payment of fees or donations. We may
withhold official copies of report cards or transcripts under Utah Code Section 53A-11-806 if
fines or other charges for lost or damaged school property have not been resolved.
C. ASSURANCES (RELATING TO THE REGULAR SCHOOL DAY)
1. No fees are charged for textbooks, equipment or supplies, field trips, assemblies, enrichment
programs such as gifted and talented programs, snacks (other than food or drinks supplied
through the School Lunch Program in accordance with state and federal rules, including
those governing free and reduced price meals), or anything else that takes place during the
regular school day.
2. Staff are prohibited from requiring students to bring items other than common household
articles from home. If donations of school materials are requested, children and families that
fail to bring such articles are not excluded, named, or otherwise humiliated in any way.
3. Although we may permit the solicitation of donations or contributions, any solicitations
clearly state that donations and contributions are voluntary, and that we do not require a
donation in order for a given student to participate in an activity.
D. ASSURANCES (OUTSIDE THE REGULAR SCHOOL DAY)
1. Our fee schedule, and fee waiver policy are in full compliance with applicable State and
federal law and with the rules of the District and State Boards of Education.
2. If after-school or school vacation programs or activities are held for which fees are charged,
we comply with school fee rules requiring Board of Education approval, notice, waiver
application, and appeal.
3. Copies of the school district's Fee Policy, Fee Waiver Policy, and the Fee Schedule approved
by the Board of Education for this school are maintained in the school and are made available
to parents and guardians during registration and at other times upon request.
4. Prior to the time when fees became due, we sent the School Fees Notice for Families of
Students in Kindergarten through Sixth Grades; and the Fee Waiver Application (Grades K-
6) to the parent or guardian of each student who was attending, had applied to attend, or was
scheduled to attend this school.
5. We undertook a general distribution of the forms listed in Section D.4. on _______________,
20____. The forms were sent in the following manner:
6. Students who apply for or receive fee waivers are allowed to register at the same time and in
the same manner as would have been the case if waivers were not involved.
7. School personnel are prohibited from asking those eligible for fee waivers to consent to
delayed or time payment plans or IOU's as alternatives to fee waivers.
8. Fundraisers offered to students as alternatives to fee waivers are appropriate to the age,
physical condition, and maturity of the student, and are conducted in such a way that students
are not subjected to stigma, unnecessary identification as fee-waiver students, or to ridicule
9. Fundraising activities avoid excessive burdens on students and families and give proper
consideration to a student's transportation needs and other responsibilities. If it is not
reasonably feasible to arrange an assignment meeting those requirements, the fees in question
10. In the case of programs, classes, and activities which are subject to fees and require “tryouts”
a. persons involved in the selection process are not informed about the fee waiver eligibility
of any student until selections have been announced;
b. questions and discussions relating to ability to pay are prohibited during the selection
c. ability to pay is not a factor in the selection process; and
d. no fees relating to the program, class, or activity in question are collected from any
student until the selection process has been completed.
11. We provide the Fee Waiver Application (Grades K-6) to each prospective, new, or current
student's parent or guardian who requests information about school fees or seeks to apply for
a fee waiver.
12. We use the Fee Waiver Decision and Appeal Form to notify applicants about decisions
relating to their applications for waivers.
13. We do not collect school fees, whether class, project, or activity fees, or require students to
purchase materials or supplies, unless the fees or other requirements have been approved by
the district's School Board and are listed on this school's approved fee schedule.
14. We waive fees for eligible students if a class or program outside of regular school hours is
established or approved which requires payment of fees or purchase of materials, special
clothing, tickets to events, etc., in order for students to participate fully.
15. We use confidential application and notice procedures regarding school fees and school fee
waivers to avoid stigmatizing or embarrassing students or families applying for or receiving
fee waivers. The procedures for confidentiality include, but are not limited to, the following:
a. we do not use a separate line during registration for families or individuals seeking to
obtain a school fee waiver;
b. we do not discuss or determine a student's eligibility for school fee waivers in the
presence of other parents or children;
c. we do not use students to collect fees or assist in the fee waiver application process.
16. We do not ask any student, parent, or guardian why school fees cannot be paid or why fees
cannot be paid later or in installments when information about school fee waivers is sought
or an application is submitted for a school fee waiver, except that a school will require
documentation consistent with Section 53A-12-103(5) and local board policies and/or
guidelines requiring documentation, if the affected student is eligible for a school fee waiver
under any of the following categories:
a. the student is eligible based on income verification;
b. the student receives (SSI)* Supplemental Security Income (only for blind or disabled
c. the family receives AFDC (currently qualified for financial assistance or food stamps);
d. the student is in Foster Care (under Utah or local governmental supervision); or
e. the student is in State Custody.
17. Persons not included under Section D.16. who request waivers because of exceptional
financial hardships are given the opportunity to meet privately with a school administrator to
discuss their ability to pay and their eligibility for fee waivers.
18. We provide reasonable assistance to persons who lack sufficient mastery of the English
language to understand the provisions of the fee schedules, disclosures, and waiver
19. Our school (if the school charges fees of any kind as defined under R277-407-1A or Doe v.
Utah State Board of Education, Civil No. 920903376), adequately required fee waiver
eligibility documentation consistent with Section 53A-12-103(5).
20. OUR SCHOOL DOES NOT RETAIN DOCUMENTATION OF FEE WAIVER
NOTE: Schools may transfer fee waiver eligibility information to other schools to which
students advance or transfer.
FINAL NOTE: If your district does not require parents in the entire district area or parents and
students in specific schools or sections of the district to "apply for fee waivers," district
administrators NEED NOT require verification of eligibility under this section.
I HEREBY CERTIFY THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT
TO THE BEST OF MY KNOWLEDGE AND BELIEF.
DATED this _______ day of _________________, 20___ ______________________________
(Signed) School Principal