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YOUTH INFORMATON:
Is youth eligible for Independent Living Services? YES:
eligible for IL services)
(Note: Waivers cannot be issued unless
2015/2016 SAT FEE WAIVER REQUEST FORM
First Name:
Middle Initial:
Last Name:
Please email this completed form as an attachment to Melissa Moore at mcm141@pitt.edu
DatePlease
of Birth:
/
/is a form fillableGender:
Male
Female
Note: This
document.
You will find
it easier to complete if you type the
information rather than write it. As a way of being environmentally responsible, these forms are filed
Year
youth will graduate:
Please
Select
electronically.
We encourage
everyone
to One
return the form via email as a word attachment. If you are
unable to send via email, please type the information and either fax to 717-795-8013 or send US mail to
CWRC, Attn: Melissa Moore, 403 E. Winding Hill Rd, Mechanicsburg, PA 17055. Thank You.
Today’s
Click here
to ONE
enter SAT
a date.
County:
PLEASEDate:
CHECK
ONLY
TEST DATE:
TEST Type
DATE:
8
Select
of SAT Waiver: October 11
Reasoning TestNovemberSubject
Test December 6
Registration Deadline: (September 12)
(October 9)
(November 6)
REQUESTOR INFORMATION:
(Note:
to students.
Waivers
will be14mailed to the Requestor
TEST Waivers
DATE: will not be mailed
January
24
March
May 2 address)
June 6
Registration Deadline: (December 29)
(February 13)
(April 6)
(May 8)
Name:
Phone:
Ext:
Email:
Comments:
Requestor Street Address:
City:
State:
Zip Code:
CWRC Use Only:
Agency Code:
Date Mailed:
/
/
Notes:
YOUTH INFORMATION:
Is youth eligible for Independent Living Services?
eligible for IL services)
First Name:
Date of Birth:
Middle Initial:
/
/
YES (Note: Waivers cannot be issued unless
Last Name:
Gender:
Male
Female
Year youth will graduate: 2015
PLEASE CHECK ONLY ONE TEST DATE:
TEST DATE:
Registration Deadline:
October 3
(September 3)
November 7
(October 9)
TEST DATE:
Registration Deadline:
January 23
(December 28)
March 5
(February 13)
Comments:
CWRC Use Only:
Agency Code:
Date Mailed:
December 5
(November 5)
May 7
(April 8)
June 4
(May 5)