Parent Education Fee Waiver/Reduction Form
Multnomah County Family Resolution Services
1200 SW 1st Ave., Ste. 3400
phone: 503-988-3037
email: multco.parented@multco.us
website: https://www.multco.us/family-resolution
Please select your preferred language.
We will let you know whether you qualify to have your fees waived or reduced within 48 hours after you submit the form. Please
do not pay the registration fee
or register for a class before you hear back from us. We won't be able to refund your payment if you have your fees waived.
Client Information
First Name
Last Name
Middle Name (if any)
Date of Birth
Email Address
Phone Number
Alternate Phone Number (if any)
Court Information
Multnomah County Court Case Number (
N/A if you have not
yet filed a case with the court
)
If you have not yet filed a court case, are you planning to file in Multnomah County when you do file?
Yes
No
What is the name of the other person in your case?
Financial Information
How much do you earn from a job each month before taxes (list average of the past 3 months if it varies)? Your answer can be "0.00".
How much money do people who live with you and share your expenses earn from a job each month before taxes? Your answer can be "0.00".
How much money do you receive for disability benefits or social security before taxes each month? Your answer can be "0.00".
How much money do
people who live with you and share your expenses
receive for disability benefits or social security before taxes each month? Your answer can be "0.00".
How much money do you receive from TANF (cash benefits) before taxes each month? Your answer can be "0.00".
How much money do
people who live with you and share your expenses
receive
from TANF (cash benefits) before taxes each month? Your answer can be "0.00".
How much money do you receive in unemployment benefits before taxes each month? Your answer can be "0.00".
How much money do
people who live with you and share your expenses
receive in unemployment benefits before taxes each month? Your answer can be "0.00".
How much money do you pay in child support each month? Your answer can be "0.00".
How much money do you pay for child care each month? Your answer can be "0.00".
How many people live on the income you listed (including yourself and any other dependents you have)?
1
2
3
4
5
6
7
8 or more
Safety Alerts
Criminal No Contact Order
Yes
No
Domestic Violence / Safety Concern
Yes
No
Stalking Order
Yes
No
Threat to Staff
Yes
No
Restraining Order
Yes
No
Mediation Safety Concern
Yes
No
Language
Interpreter Required
Yes
No
Language Spoken
Please select...
Afrikaans
Irish
Albanian
Italian
Arabic
Japanese
Azerbaijani
Kannada
Basque
Korean
Bengali
Latin
Belarusian
Latvian
Bulgarian
Lithuanian
Catalan
Macedonian
Chinese Simplified
Malay
Chinese Traditional
Maltese
Croatian
Norwegian
Czech
Persian
Danish
Polish
Dutch
Portuguese
English
Romanian
Esperanto
Russian
Estonian
Serbian
Filipino
Slovak
Finnish
Slovenian
French
Spanish
Galician
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Gujarati
Thai
Haitian Creole
Turkish
Hebrew
Ukrainian
Hindi
Urdu
Hungarian
Vietnamese
Icelandic
Welsh
Indonesian
Yiddish
Electronic Signature
Other Information
Please type your name to certify that your answers are true and you want to apply to have your parent education registration fees waived or reduced.
We will let you know whether you qualify to have your fees waivered within 48 hours. Please do not pay the registration fee in the meantime, as we have a no-refund policy.
Office Use Only
Please do not fill out these questions.
Based on the above information, the client
Qualifies
Partially Qualifies
Does Not Qualify
Total monthly income
OFFICE USE ONLY: Staff Initials
Income
Deductions
Contact Information