Please complete the below Household Economic Survey
for consideration if your household qualifies for:

• Free or Reduced Registration Fees

• Drivers Education (fees are assessed by the company providing service, please contact that company for more information)

• Clinton Parks & Recreation Activity Fees (contact this organization for more information)

(*this is a print only* you will need to print this off, complete & return):

2023-2024 Household Economic Survey/Fee Waiver.

• Once the survey is completed it will need to be turned in to the Nutrition Service’s Office at the Administration Building and/or to your child(ren)’s school, by email, by fax @ (563) 242-2154, or by mail to: Nutrition Service’s, 1401 12th Ave N, Clinton, IA 52732.

• Household Economic Surveys may also be picked up at any of the schools, or at the Nutrition Service’s Office at the Administration Center.

For any questions please feel free to contact our department at (563) 243-7780 and/or by email. (kim.leeper@csdkq.org)

Thank you.