Student Name
Lastname
,
Firstname
-
ID#
Lunch Fees
Reduced Lunch Monthly:
$8.00
Select:
Item Subtotal:
$0.00
Reduced Lunch Yearly:
$72.00
Select:
Item Subtotal:
$0.00
Regular Lunch Monthly:
$50.00
Select:
Item Subtotal:
$0.00
Regular Lunch Yearly:
$450.00
Select:
Item Subtotal:
$0.00
Other Lunch Amount:
$
Item Subtotal:
$0.00
*All applications for free or reduced lunch must be submitted online at
http://MSD.heartlandapps.com
for processing.
Grade 6
Writing Fee (Mandatory):
$6.00
Select:
Item Subtotal:
$0.00
Year Book (Optional):
$17.00
Select:
Item Subtotal:
$0.00
Activity Fee (Optional):
$15.00
Select:
Item Subtotal:
$0.00
Grade 7
Writing Lab (Mandatory):
$6.00
Select:
Item Subtotal:
$0.00
Locker Fee (Mandatory):
$1.00
Select:
Item Subtotal:
$0.00
CTE (Mandatory for all 7th):
$6.00
Select:
Item Subtotal:
$0.00
Beginning Fitness (Mandatory for all 7th):
$15.00
Select:
Item Subtotal:
$0.00
Art (Mandatory if Enrolled):
$5.00
Select:
Item Subtotal:
$0.00
Band (Mandatory if Enrolled):
$10.00
Select:
Item Subtotal:
$0.00
Chorus (Mandatory if Enrolled):
$5.00
Select:
Item Subtotal:
$0.00
Drama (Mandatory if enrolled):
$10.00
Select:
Item Subtotal:
$0.00
Orchestra (Mandatory if Enrolled):
$10.00
Select:
Item Subtotal:
$0.00
Activity Fee (Optional):
$15.00
Select:
Item Subtotal:
$0.00
Yearbook (Optional):
$17.00
Select:
Item Subtotal:
$0.00
Grade 8
Writing Lab (Mandatory):
$6.00
Select:
Item Subtotal:
$0.00
Locker Fee (Mandatory):
$1.00
Select:
Item Subtotal:
$0.00
Intermediate Fitness (Mandatory for all 8th):
$15.00
Select:
Item Subtotal:
$0.00
Keyboarding (Mandatory for all 8th):
$3.00
Select:
Item Subtotal:
$0.00
Art (Mandatory if Enrolled):
$5.00
Select:
Item Subtotal:
$0.00
Band (Mandatory if Enrolled):
$10.00
Select:
Item Subtotal:
$0.00
Chorus (Mandatory if Enrolled):
$5.00
Select:
Item Subtotal:
$0.00
Drama (Mandatory if enrolled):
$10.00
Select:
Item Subtotal:
$0.00
Exploring Technology (Mandatory if enrolled):
$10.00
Select:
Item Subtotal:
$0.00
Orchestra (Mandatory if Enrolled):
$10.00
Select:
Item Subtotal:
$0.00
Activity Fee (Optional):
$15.00
Select:
Item Subtotal:
$0.00
Year Book (Optional):
$17.00
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
Method of Payment:
Visa
MasterCard
Discover Card
Personal Checking
Personal Savings
Business Checking
Processing Fees:
Credit cards:
3% plus $0.50 ($1.50 min)
(+1.5% processing fee for foreign cards)
eChecks:
$0.49
Update name from
Parent/Guardian Information
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number:
Expiration Date:
01
02
03
04
05
06
07
08
09
10
11
12
/
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
Card ID (CVV2/CID) Number:
What is the Card ID?
Cardholder Information
(exactly as it appears on your statement)
Update from
Parent/Guardian Information
Cardholder's Name:
Billing ZIP/Postal Code:
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
I Understand
This payment will be posted to Delta Middle School.
Please be aware that payments will reflect on your statement as
Schools 800-764-0844 Clinton UT
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