2024/2025 ACT/SAT WAIVER ELIGIBILITY VERIFICATION

________________________________________ _________________________________ ___________

Student Name (Please Print) Student Number Grade

In an effort to remain in compliance with College Board (SAT) and ACT fee waiver distribution guidelines, we ask that you
review the following document, indicate the category that applies to your family by initialing on the appropriate line,
sign and return to your school counselor.

Fee Waiver Eligibility

If you’re a high school student who lives in the United States or its territories, or who is a U.S. citizen residing outside the
U.S., you may be able to receive fee waivers. To be eligible, you must meet at least one of the criteria below.

Please check one:

_____ Enrolled in or eligible to participate in the federal National School Lunch Program (NSLP).
*All DCPS students are eligible to participate in free lunch at school so please be sure to check off one
of the other ones that apply to you.
_____ Annual family income falls within the Income Eligibility Guidelines set by the USDA Food and Nutrition
Service (provided below).
_____ Enrolled in a federal, state, or local program that aids students from low-income families (e.g., Federal
TRIO programs such as Upward Bound).
_____ Family receives public assistance.
_____ Live in federally subsidized public housing, are in a foster home, or are homeless.
_____ Ward of the state or an orphan.
_____ None of the above apply to my family.

USDA Food and Nutrition Service Income Eligibility Guidelines for 2024-2025

NUMBER OF MEMBERS IN HOUSEHOLD TOTAL ANNUAL INCOME

(including head of household)1 (in preceding calendar year)2

1 $27,861
2 $37,814
3 $47,767
4 $57,720
5 $67,673
6 $77,626
1. The household size should be the number of household members plus the filer on the family’s current income tax
statement. A student who is in foster care is considered a household size of one person.
2. Income levels are based on the USDA Food and Nutrition Service Income Eligibility Guidelines for free or reduced-
price meals used by schools, institutions, and facilities participating in the National School Lunch Program (NSLP). To see
the complete table of guidelines, go to fns.usda.gov/slp and select Income Eligibility.

More than six members in the household? To determine income levels for families with more than six household
members, take the annual allowance for six members, $77,626 and add $9,953 for each additional member.

My signature certifies that the above information is true and correct as indicated.

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Parent Name (Please Print) Parent Signature Phone Number