UHS Reduced Fee Request Form

UHS Reduced Fee Request Form
UAlbany in the High School offers a reduced program fee for students who qualify for Free or Reduced Lunch through the National School Lunch Program. To verify your eligibility, complete the form below.

Please note: Forms with incomplete or incorrect information will not be processed.

Once your school reviews your request, you will receive a confirmation email with your eligibility status:
- If eligible: You will receive a promotional code that you can use to register for the course at the reduced rate.
- If not eligible: You will need to register for the course at the standard rate.
UHS Academic Year
SECTION A. To be completed by student
Student Name

First NameLast Name
Student Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student Personal Email
example@personal.com
High School Name
High School Guidance Counselor or Principal Name

First NameLast Name
High School Guidance Counselor or Principal Email
Check for accuracy!
High School Official Title
Guidance Counselor, Principal, Dean
NOTE: Please double check that you have entered all email addresses correctly. If the email is entered incorrectly, the form will not be processed.

If you do not know your school's Guidance Counselor or Principal information, please check with your High School prior to submitting this form.
Once you submit Section A of this form, your High School Guidance Counselor or Principal will receive an email to complete Section B. Please note that it is your responsibility to follow up with your Guidance Counselor or Principal to make sure they receive and complete Part B of this form. In order for this request to be processed, both sections must be completed.

By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application.

When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your submission.
Student Signature
Student Signature Date

MonthDayYear
Date
Please verify that you are human

UHS Reduced Fee Request Form
UAlbany in the High School offers a reduced program fee for students who qualify for Free or Reduced Lunch through the National School Lunch Program. To verify your eligibility, complete the form below.

Please note: Forms with incomplete or incorrect information will not be processed.

Once your school reviews your request, you will receive a confirmation email with your eligibility status:
- If eligible: You will receive a promotional code that you can use to register for the course at the reduced rate.
- If not eligible: You will need to register for the course at the standard rate.
UHS Academic Year
SECTION A. To be completed by student
Student Name

First NameLast Name
Student Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student Personal Email
example@personal.com
High School Name
High School Guidance Counselor or Principal Name

First NameLast Name
High School Guidance Counselor or Principal Email
Check for accuracy!
High School Official Title
Guidance Counselor, Principal, Dean
NOTE: Please double check that you have entered all email addresses correctly. If the email is entered incorrectly, the form will not be processed.

If you do not know your school's Guidance Counselor or Principal information, please check with your High School prior to submitting this form.
Once you submit Section A of this form, your High School Guidance Counselor or Principal will receive an email to complete Section B. Please note that it is your responsibility to follow up with your Guidance Counselor or Principal to make sure they receive and complete Part B of this form. In order for this request to be processed, both sections must be completed.

By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application.

When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your submission.
Student Signature
Student Signature Date

MonthDayYear
Date
SECTION B. To be completed by High School Guidance Counselor or Principal

Note: this section is ONLY to be completed by the High School Guidance Counselor or Principal
High School Name
High School Guidance Counselor or Principal Name

First NameLast Name
High School Guidance Counselor or Principal Email
example@example.com
High School Official Title
Guidance Counselor, Principal, Dean
Please certify that your High School records indicate that the student listed above either is participating or is eligible to participate in the Federal Reduced/Free Lunch Program
Verification Decision
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application.

When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your submission.
High School Guidance Counselor or Principal Signature
High School Signature Date

MonthDayYear
Date
Should be Empty:

UHS Reduced Fee Request Form

SECTION A. To be completed by student

UHS Reduced Fee Request Form

SECTION A. To be completed by student

SECTION B. To be completed by High School Guidance Counselor or Principal