McCall Public Library

MCCALL PUBLIC LIBRARY

FEE WAIVER REQUEST

CONFIDENTIAL INFORMATION

McCall Public Library wants everyone in our community to have the opportunity to use our library, regardless of their financial situation.  For this reason, the City of McCall, through it's City Manager, will waive the monetary requirement for non-resident families in certain circumstances.  Outlined below are the policies and procedures for approval:

1.  Approved waivers are based on WICAP/Headstart,  National School Lunch Program Guidelines and/or Medicare Medicaid, along with total household income, and completeness of request form.

2.  Each request must be accompanied by proof of participation in WICAP/Headstart,  National School Lunch Program and/or Medicare, Medicaid eligibility.   

3.   Please attach any other information you think is needed for the city manager to evaluate your request.

I HAVE READ AND UNDERSTAND THE INFORMTION ABOVE:_____________________________

                                                                                                               Signature of person requesting waiver

Please complete the following:

Parent/Guardian (person requesting waiver):_____________________________Date:_____________

Home address:_________________________________P.O. Box_______________________

City:________________Zip________________Home#_________________Work#___________________

Total Number in household_________Marital Status:  Single____Maried___Widowed___Divorced______

Gross Monthly income $______________

PLEASE DO NOT WRITE BELOW THIS LINE

______________________________________________________________________________________

APPROVED/DENIED:_____________________________________________Date:_________________

                                       City Manager