CONFIDENTIAL APPLICATION FOR PROGRAM FEE WAIVER OR REDUCTION
For additional information, please contact: Brenda Vales, 4-H Community Educator II @ bcvales@ucanr.edu.
Youth Member's First Name: ✻
Last Name: ✻
Household Email Address ✻
4-H Club Name: ✻
I am requesting a fee waiver as indicated by the checked box:
(Reference: https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines) ✻
To determine eligibility for a full waiver or reduction of the program fee, please indicate if: Annual household cash income is at or below $54,150. See Reference: https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines. 2025-2026 Federal Poverty guidelines. If yes, you are eligible to apply for a reduction or waiver of your 4-H program fees. ✻
You may share additional information.
Is there a reason other than household income that you are requesting this financial aid?
I do hereby confirm that the above information is accurate. Parents/Guardians Name: ✻
UC 4-H reserves the right to verify the above information by further reviewing the household financial status with the parent/guardian.
