Delta Middle School

Your statement will describe your payment as ‘CBT*MILLARD SCHOOL DI’ and the service fee transaction as ‘CBT*SVC FEE MILLARD S’

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Student Name	Lastname	,	Firstname	-	ID#
Student Name

Lunch Fees

Reduced Lunch Monthly*:

$8.00

Select:

Item Subtotal:

$0.00

Reduced Lunch Yearly*:

$72.00

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Item Subtotal:

$0.00

Regular Lunch Monthly:

$50.00

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Item Subtotal:

$0.00

Regular Lunch Yearly:

$450.00

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Item Subtotal:

$0.00

Other Lunch Amount:

Item Subtotal:

$0.00

*Applications for free or reduced lunch can be submitted online at

https://www.schoollunchapp.com

Grade 5

Yearbook (Optional):

$20.00

Select:

Item Subtotal:

$0.00

Grade 6

Writing Fee (Mandatory):

$6.00

Select:

Item Subtotal:

$0.00

Yearbook (Optional):

$20.00

Select:

Item Subtotal:

$0.00

Grade 7

Writing Lab (Mandatory):

$6.00

Select:

Item Subtotal:

$0.00

CCA (Mandatory):

$6.00

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Item Subtotal:

$0.00

Fitness (Mandatory):

$20.00

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Item Subtotal:

$0.00

Art:

$15.00

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Item Subtotal:

$0.00

Band:

$15.00

Select:

Item Subtotal:

$0.00

Band (Concert):

$15.00

Select:

Item Subtotal:

$0.00

Chorus:

$5.00

Select:

Item Subtotal:

$0.00

Creative Coding:

$10.00

Select:

Item Subtotal:

$0.00

Discovering Stem:

$10.00

Select:

Item Subtotal:

$0.00

Drama:

$15.00

Select:

Item Subtotal:

$0.00

Graphic Art:

$10.00

Select:

Item Subtotal:

$0.00

Musical Theatre:

$10.00

Select:

Item Subtotal:

$0.00

Orchestra:

$15.00

Select:

Item Subtotal:

$0.00

Percussion:

$15.00

Select:

Item Subtotal:

$0.00

Yearbook (Optional):

$20.00

Select:

Item Subtotal:

$0.00

PE Shirt (Optional):

$5.00

Select:

Item Subtotal:

$0.00

PE Shorts (Optional):

$7.00

Select:

Item Subtotal:

$0.00

PE Joggers (Optional):

$15.00

Select:

Item Subtotal:

$0.00

PE Leggings (Optional):

$19.00

Select:

Item Subtotal:

$0.00

Grade 8

Writing Lab (Mandatory):

$6.00

Select:

Item Subtotal:

$0.00

Digital Literacy (Mandatory):

$3.00

Select:

Item Subtotal:

$0.00

Fitness (Mandatory):

$20.00

Select:

Item Subtotal:

$0.00

Art:

$15.00

Select:

Item Subtotal:

$0.00

Band:

$15.00

Select:

Item Subtotal:

$0.00

Band (Concert):

$15.00

Select:

Item Subtotal:

$0.00

Chorus:

$5.00

Select:

Item Subtotal:

$0.00

Creative Coding:

$10.00

Select:

Item Subtotal:

$0.00

Discovering Stem:

$10.00

Select:

Item Subtotal:

$0.00

Drama:

$15.00

Select:

Item Subtotal:

$0.00

Exploring Technology:

$15.00

Select:

Item Subtotal:

$0.00

Graphic Art:

$10.00

Select:

Item Subtotal:

$0.00

Musical Theatre:

$10.00

Select:

Item Subtotal:

$0.00

Orchestra:

$15.00

Select:

Item Subtotal:

$0.00

Percussion:

$15.00

Select:

Item Subtotal:

$0.00

Yearbook (Optional):

$20.00

Select:

Item Subtotal:

$0.00

PE Shirt (Optional):

$5.00

Select:

Item Subtotal:

$0.00

PE Shorts (Optional):

$7.00

Select:

Item Subtotal:

$0.00

PE Joggers (Optional):

$15.00

Select:

Item Subtotal:

$0.00

PE Leggings (Optional):

$19.00

Select:

Item Subtotal:

$0.00

Total:

$0.00

Parent/Guardian Information

First Name:	Last Name:
Address:
Address:
City:	State/Province:	ZIP/Postal Code:
Phone:
Email:

Payment Information:

Processing Fee Rates:
Cards:	3% plus $0.50 ($1.50 min) (1.5% surcharge for foreign cards)
eCheck:	$0.49

Method of Payment:	E-Check
Update Name from Above

Name on Account:
Routing Number:
Account Number:
Institution:

Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:

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Be Aware that this payment will be posted to the Delta Middle School. If your student is not attending the Delta Middle School, do not pay on this payment page as it will delay your funds being posted to your account. Please use one of the other payment links listed below.

Payment links for other Millard County Schools

Delta South Elementary

Delta North Elementary

Delta High School

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This payment will be posted to Delta Middle School.


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