Fee Waiver Information

Download and complete the fee waiver application for consideration

Submissions may be accepted in-person or emailed, as an attachment, to:

Rene Valdez, rvaldez@lths.net, (grades 9/10)
Bryan Radavich, bradavich@lths.net (grades 11/12)

Please also submit your 1040 tax form from the previous year's tax return.

Fee Waiver Information

Lyons Township High School has adopted a school policy to provide for a waiver of fees and free lunch. In order to be eligible for these services:

Documentation must be submitted indicating that your household income falls within the Federal Income Guidelines (see chart below).
In order to apply for a fee waiver or to participate in the free lunch program, please complete one on-line or hard-copy application per household each school year.
If you are applying to have your student’s school fees waived, you will also need to provide proof of income from the previous year’s Federal Tax return (1040).
If your employment status has changed since filing, you are able to complete the form- but we may request further documentation to verify your eligibility status. Examples of supporting documentation may include a current pay stub, IDES benefits statement, notice of termination, SSI benefit statement, etc. Failure to provide documentation will delay the verification process.
If you received direct-certification for an approved fee waiver, you do not need to fill out this application. Direct-certification letters were mailed to families indicating eligibility in July/August 2024.

FEE WAIVER ELIGIBILITY GUIDELINES 2024-25

Household Size	Annual	Monthly	Twice Per Month	Every Two Weeks	Weekly
1	19,578	1,632	816	753	377
2	26,572	2,215	1.108	1,022	511
3	33,566	2,798	1,399	1,291	646
4	40,560	3,380	1,690	1,560	780
5	47,544	3,963	1,982	1,829	915
6	54,548	4,546	2,273	2,098	1,049
7	61,542	5,129	2,565	2,367	1,184
8	68,536	5,712	2,856	2,636	1,318
For each additional family member, add	6,994	583	292	269	135

*Income is defined as any monies earned before any deductions such as income taxes, social security taxes, insurance premiums, charitable contributions and bonds. It includes the following (1) monetary compensation for services including wages, salary commissions, or fees; (2) net income from non-farm self-employment; (3) net income from farm self- employment; (4) social security; (5) dividends or interest on savings or bonds or income from estates or trusts; (6) net rental income; (7) public assistance or welfare payments; (8) unemployment compensation; (9) government civilian employee or military retirement or pensions or veteran payments; (10) private pensions or annuities; (11) alimony or child support payments; (12) regular contributions from persons not living in the household; (13) net royalties; and (14) other cash income. Other cash income would include cash amounts received or withdrawn from any source including savings, investments, trust accounts, and other resources which would be available to pay the price of a student’s fees or meal.

Included in Fee Waiver

Textbook rental
Student support fee
Technology fee
Driver's education fee
Woods class materials (least expensive project)
Paperback books, workbooks (consumables)
Safety goggles, if required
Gym uniform/heartrate strap – 1 uniform at SC / 1 uniform at NC
PE lock rental– one lock for all four years
Graphing calculator rental, if required
LTHS Parent Teacher Council directory and calendar
*Corral Pass
Mandatory fieldtrip fees
Technology Center of DuPage fees
**Graduation cap and gown
**Yearbook

*Freshmen & Sophomores only **Seniors only

Not Included in Fee Waiver

Admission to school dances or special events
General classroom supplies (pens/pencils, notebook paper, folders, binders, etc.)
Technology repair / replacement fees
Library fines
Class or team pictures
Optional fieldtrips
Parking fees
Any damages, repair, or replacement to district owned technology
Sport or club optional items
Yearbook
**Prom, post-prom, and senior breakfast
**Senior pictures (No sitting fee charge for yearbook photo)

**Seniors only

Instructions for Applying

Complete and Submit one application per household per school district

If your household receives SNAP or TANF benefits, follow these instructions:

If no one in your household gets SNAP or TANF benefits and if any child in your household is homeless, a migrant or runaway or head start/even start, follow these instructions:

Part 1: List all household members and the name of school for each child.
Part 2: If any child you are applying for is homeless, migrant, or a runaway check the appropriate box and call your school.
Part 3: Complete only if a child in your household isn’t eligible under Part 2. See instructions for All Other Households.
Part 4: Sign the form.
Part 5: Provide Contact Information.

If you are applying for a foster child, follow these instructions:

If all children in the household are foster children that are the legal responsibility of a foster care agency or court:

Part 1: List all foster children and the school name for each child. Check the “Foster Child” box for each foster child.
Part 2: Skip this part.
Part 3: Skip this part.
Part 4: Sign the form.
Part 5: Provide Contact Information.

If some of the children in the household are foster children that are the legal responsibility of a foster care agency or court:

Part 1: List all household members and the name of school for each child. Check the “Foster Child” box for each foster child.
Part 2: If any child you are applying for is homeless, migrant, or a runaway check the appropriate box and call your school.
Part 3: Follow these instructions to report total household income from this month or last month.

Box 1–Name: List all household members with income.
Box 2 –Gross Income and How Often It Was Received: For each household member, list each type of income received for the month. You must tell us how often the money is received—weekly, every other week, twice a month or monthly. For earnings, be sure to list the gross income, not the take-home pay. Gross income is the amount earned before taxes and other deductions. You should be able to find it on your pay stub or your boss can tell you. For other income, list the amount each person got for the month from welfare, child support, alimony, pensions, retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits (VA benefits), and disability benefits. Under All Other Income, list Worker’s Compensation, unemployment or strike benefits, regular contributions from people who do not live in your household, and any other income. Do not include income from SNAP, FDPIR, WIC, Federal education benefits and foster payments received by the family from the placing agency. For ONLY the self-employed, under Earnings from Work, report income after expenses. This is for your business, farm, or rental property. If you are in the Military Privatized Housing Initiative or get combat pay, do not include these allowances as income.

Part 4: Sign the form.
Part 5: Provide Contact Information

All other households including Medicaid and WIC households, follow these instructions:

Part 1: List all household members and the name of school for each child.

Part 2: If any child you are applying for is homeless, migrant, or a runaway check the appropriate box and call your school.

Part 3: Follow these instructions to report total household income from this month or last month.

Box 1–Name: List all household members with income.
Box 2 –Gross Income and How Often It Was Received: For each household member, list each type of income received for the month. You must tell us how often the money is received—weekly, every other week, twice a month or monthly. For earnings, be sure to list the gross income, not the take-home pay. Gross income is the amount earned before taxes and other deductions. You should be able to find it on your pay stub or your boss can tell you. For other income, list the amount each person got for the month from welfare, child support, alimony, pensions, retirement, Social Security, Supplemental Security Income (SSI), Veteran’s benefits (VA benefits), and disability benefits. Under All Other Income, list Worker’s Compensation, unemployment or strike benefits, regular contributions from people who do not live in your household, and any other income. Do not include income from SNAP, FDPIR, WIC, Federal education benefits and foster payments received by the family from the placing agency. For ONLY the self-employed, under Earnings from Work, report income after expenses. This is for your business, farm, or rental property. Do not include income from SNAP, FDPIR, WIC or Federal education benefits. If you are in the Military Privatized Housing Initiative or get combat pay, do not include these allowances as income.

Part 4: Sign the form.
Part 5: Provide Contact Information

Additional application information

Privacy Act Statement: This explains how we will use the information you give us. The Richard B. Russell National School Lunch Act requires the information on this application. You do not have to give the information, but if you do not, we cannot approve your child for free or reduced price meals. You must include the last four digits of the social security number of the adult household member who signs the application. The last four digits of the social security number is not required when you apply on behalf of a foster child or you list a Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) Program or Food Distribution Program on Indian Reservations (FDPIR) case number or other FDPIR identifier for your child or when you indicate that the adult household member signing the application does not have a social security number. We will use your information to determine if your child is eligible for free or reduced price meals, and for administration and enforcement of the lunch and breakfast programs. We MAY share your eligibility information with education, health, and nutrition programs to help them evaluate, fund, or determine benefits for their programs, auditors for program reviews, and law enforcement officials to help them look into violations of program rules.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/ complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. This institution is an equal opportunity provider.

School Lunch Information

School lunch is provided by Sodexo.

There is little doubt that having a tasty, healthy lunch will provide you with the necessary boost to proceed with your day of learning. Each full school day, you can select one entrée, one side and one milk.

Select 1 Entrée Choice:

Higher Fiber/Low Fat Cheese Pizza Slice Beef-Mushroom Hamburger or Cheeseburger
Pre-packaged Turkey, Ham or PBJ Sandwich on Bread (Does not include “Simply To Go sandwiches)
Wholegrain Breaded Chicken Patty Sandwich Prepackaged Entrée Salads (Garden Salad & Fried Chicken Salad)
*Low Fat Beef Fiesta Nachos, *Beef Hot Dog, *State Fair Corn Dog, BBQ Rib Sandwich.

(Items with asterisk ( * ) rotate on our monthly menu. Please see menu for availability.)

Any new item available to Lunch Program participants will be designated on the Countertop Menu Sign at each serving area.

Select 1 Side Choice:

Gelatin Cup, Tropical, Peach, Pear or Mixed Fruit Cup, Applesauce Cup, Pre-Packaged Garden Side Salad (does not include Caesar Side Salad), Fresh Whole Apple, Banana or Orange

Select 1 Milk Choice:

1% White, Skim Chocolate or Skim White Milk (Arrangements can be made for those students that are lactose intolerant; however, medical documentation must be provided to the Nurses’ Office. Please see the cafeteria manager.)

All lunch program students must swipe their ID cards. Once the card is read by the system, your account will automatically come up as a Lunch Program participant, so your status will remain anonymous. Students on the program are allowed 1 free lunch per day. Please remember, you must take all your choices (entrée, side & milk) in one transaction.

At this time, we are not allowing for any substitutions for the items listed above. If you have special dietary needs, please contact the Food Service Supervisor in the cafeteria office or by phone at 708-579-6544 (South) or 708-579-6329 (North).

School Lunch Information

Breakfast & Lunch Meal Pattern – LTHS North Campus