2024-2025 FEE WAIVER FORM Ventura County 4-H

Provisions will be made by the Ventura County 4-H to cover program fees for eligible youth who are unable to pay them. The parent/guardian of an eligible youth for which a program fee waiver or reduction is requested must complete this form.

To apply for a fee waiver for your county 4-H enrollment fees for the 2024-25 year, please complete this form:

✻ = Required

Youth Information

Last Name ✻

First name ✻

Which 4-H Club are you enrolling in? ✻

Parent / Guardian Information

Parent Name ✻

Email address ✻

Phone number ✻

What are you requesting? ✻

I am requesting a waiver of the $85 program fee in full. I am requesting a reduction of the $85 program fee.

If you are requesting a reduction in program fees, how much of the $85 fee do you need covered?

Is your monthly household income at or below 185% of the Federal Poverty guidelines? If your child is eligible for or enrolled in a free or reduced price school breakfast or lunch, you meet this criteria. ✻

Yes No

By typing your initials here, you are indicating that you understand that UC reserves the right to verify the above information by further reviewing the household financial status with the parent/guardian. ✻

Please note that if you selected partial fee waivor, the office will reach out to you with an invoice with expected payment deadline.

It is the policy of the University of California (UC) and the UC Division of Agriculture & Natural Resources not to engage in discrimination against or harassment of any person in any of its programs or activities (Complete nondiscrimination policy statement can be found at http://ucanr.edu/sites/anrstaff/files/215244.pdf). Inquiries regarding ANR’s nondiscrimination policies may be directed to UCANR, Affirmative Action Compliance & Title IX Officer, University of California, Davis, Agriculture and Natural Resources, 2801 Second Street, Davis, CA 95618 (530)750-1397.