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Seattle Public Schools Tel: 206.252.0633 Fax: 206.252.0111
2445 3
Avenue South MS 32-151 PO Box 34165 Seattle, WA 98124-1165


Seattle Public Schools (SPS) rents space in accordance with School Board Policy 4260 Use of Facilities. To
determine if your building use qualifies for free rent, please complete the following Request Form. Please note
this waiver request form does not apply to utility, security, or custodial costs specified in your Permit Application.
Waiver requests must be submitted to SPS for review at least ten (10) days prior to the event. If waiver is approved,
rental fee waivers are effective on the date of approval for the specified activity only.

School Building Requested:


Applicants Name:



Purpose of Activity:

Activity Date(s) and Time(s):

Room(s) Needed:
Ex: Cafeteria, Room 201

Number of Expected Participants:

Have you submitted your Building and Grounds Use Permit Application for this activity to
Building Rentals?

___ Yes
___ No

Organization Type:

___ District Program ___ Private, non-profit ___ Private, for profit
___ PTSA ___ Other: _________________________________

Activity Sponsorship Type:

___ None ___ District ___ PTSA
___ Other: _______________________

1) How much do you intend to charge per person to participate, if any?
If you have multiple rates, please attach your price sheet.

$____.__ per person

2) Is your activity open to ALL interested participants?

___ Yes
___ No

3) Will you offer to waive fees for ALL participants who cannot afford the cost of the

___ Yes
___ No

Seattle Public Schools Tel: 206.252.0633 Fax: 206.252.0111
2445 3
Avenue South MS 32-151 PO Box 34165 Seattle, WA 98124-1165

4) Please provide a copy of your activity application/form, highlighting the portion on your form that advertises the
availability of tuition or fee waivers.

5) Based on the Community Classifications in Attachment 1 of this form, is this activity
School Related or Non-School Related?

___ School Related
___ Non-school Related

6) Community Use Classification (Your selected
category in Attachment 1):

This waiver request serves as a request for a room rental fee waiver ONLY and creates no liability for either the Applicant
or Seattle Public Schools. Approval of this request by SPS does NOT confirm availability or authorization to occupy the
facilities until a permit is confirmed and issued by the Building Rentals Office.

Your signature acknowledges that you have completed the form to the best of your knowledge and understand that this
waiver request does NOT include the costs of additional requests for your use such as heat/cooling, custodial, or security.
You also acknowledge that you are authorized to sign on the behalf of the Applicant/Organization and that should your
request not meet SPS policy requirements to qualify for free rent that you agree to pay the room rental fees including any
additional requested services.

Applicant Signature: ______________________________________ Date: ___________________

Applicant Printed Name: ______________________________________


Seattle Public Schools
Attn: _____________
MS _______
P.O. Box 34165
Seattle, WA 98124

Or via Fax: ____________

Or via E-mail: ____________


This waiver request is: ___ Approved ___ Denied

Comments: ________________________________________________________________________________________

Authorized by: ___________________ Print Name: ________________ Title: _______________ Date: ______

Seattle Public Schools Tel: 206.252.0633 Fax: 206.252.0111
2445 3
Avenue South MS 32-151 PO Box 34165 Seattle, WA 98124-1165



Per Board Policy 4260SP, the following list has been provided in Section II. D. 1. to define a) School Related and b) Non-
School Related activities. Please select below which category your activity falls under (Check only one):

a. School Related

i. School related users include the following:
___ 1. PTSA events Limited to: meetings, orientations, fund-raising events and potlucks,
___ 2. School District-sponsored parent orientation meetings,
___ 3. Youth character-building activities such as Scouts, Campfire, Boys and Girls Clubs, YMCA
youth activities, and other organized youth club activities,
___ 4. Approved student groups with local school affiliation (such as drill teams),
___ 5. School District employee groups for meetings,
___ 6. Student programs other school districts,
___ 7. School alumni club meetings and tours,
___ 8. Political party caucuses.

Activities by these groups must be open to all interested participants.

b. Non-School Related

ii. Non-school related users include the following:
___ 1. Federal, state and municipal agencies, except for the Seattle Parks Department which is
treated according to a negotiated interagency agreement;
___ 2. Religious organizations;
___ 3. Political organizations;
___ 4. Fraternal organizations;
___ 5. Community club meetings;
___ 6. Class reunions, banquets, concerts, and dances;
___ 7. Privately organized activities for children (such as choral groups, drum and bugle teams,
___ 8. Organized senior citizen groups affiliated with a building-based program;
___ 9. Adult sports organizations (exclusive of those run through Parks);
___ 10. Commercial activities, e.g., private seminars, theater productions, concerts, dances,
___ 11. Other groups deemed consistent with the child education character of a school by the
School Districts Building Rental Office.