Student Fee Waiver Form

North Clackamas School District (NCSD) is committed to ensuring that all students have access to all extracurricular opportunities. The district is offering fee waivers to families that meet specific ODE income guidelines.

Previously, fee waivers were based on eligibility for Free or Reduced Meals. With all NCSD schools now qualifying for breakfast and lunch at no cost under the Community Eligibility Provision (CEP), we no longer can collect applications for free and reduced meals.

If your family meets or falls below the criteria listed in the chart shown, please complete and submit the online waiver form below. You can also download the fillable PDF form and submit it to your school.

Income Chart - Effective from July 1, 2024 through June 30, 2025

Household Size	Annual	Monthly	Twice Per Month	Every Two Weeks	Weekly
1	$27,861	$2,322	$1,161	$1,072	$536
2	$37,814	$3,152	$1,575	$1,455	$728
3	$47,767	$3,981	$1,991	$1,838	$919
4	$57,720	$4,810	$2,405	$2,220	$1,110
5	$67,673	$5,640	$2,820	$2,603	$1,302
6	$77,626	$6,469	$3,235	$2,986	$1,493
7	$87,579	$7,299	$3,650	$3,369	$1,685
8	$97,532	$8,128	$4,064	$3,752	$1,876
For each additional household member add:	$9,953	$830	$415	$383	$192

Please note: This fee waiver authorizes the North Clackamas School District to share information with our schools solely for the purpose of waiving fees.This form is for internal use only and should not be shared with external parties.

When filling out this form, I certify the following:

Our family income meets or falls below the criteria stated above,
that all information provided is accurate, and
that I understand that the District reserves the right to verify any submitted information, including family income.