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After completing all the relevant questions below, give this form to your secondary school counselor or another school official who knows you better. If applying
a mail, please also give that school official stamped envelopes addressed to each institution.
Legal Name ___________________________________________________________________________________________________________________
Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.
Birth Date ___________________________________________________ CAID (Common App ID) _______________________________________________
Address ________________________________________________________________________________________________________________________
Number & Street Apartment # City/Town State/Province Country ZIP/Postal Code
School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________
Our member colleges want to make sure that application fees do not pose a barrier for any student who wishes to apply for admission. You must meet at least
one of the following indicators of economic need to qualify for an application fee waiver. Check all that apply:
p I have received or am eligible to receive an ACT or SAT testing fee waiver
I am enrolled in or am eligible to participate in the Federal Free or Reduced Price Lunch program (FRPL)
p My annual family income falls within the Income Eligibility Guidelines set by the USDA Food and Nutrition Service
p I am enrolled in a federal, state, or local program that aids students from low-income families (e.g., TRIO programs such as Upward Bound)
p My family receives public assistance
p I live in federally subsidized public housing, a foster home or am homeless
p I am a ward of the state or an orphan
p I can provide a supporting statement from a school official, college access counselor, financial aid officer, or community leader
I certify that I understand and meet the eligibility requirements to request an admission application fee waiver. I also understand if I am a first year student my
counselor will be asked to verify my eligibility.
Signature _________________________________________________________________________________________________ Date _____________________
Please confirm the eligibility selections indicated by the applicant above. Attach any supporting documents. Be sure to sign below before mailing directly to the college/
university admission office.
Counselor’s Name (Mr./Mrs./Ms./Dr.) ________________________________________________________________________________________________
Please print or type
Title ___________________________________________________________ School _______________________________________________________
School Address ________________________________________________________________________________________________________________
Number & Street City/Town State/Province Country ZIP/Postal Code
School Website Address _________________________________________________________________________________________________________
Counselor’s Telephone (_______) ________________________________________ Counselor’s Fax (_______) _________________________________________
Area/Country/City Code Number Ext. Area/Country/City Code Number
School CEEB/ACT Code ____________________________________ Counselor’s E-mail _________________________________________________________
Signature _________________________________________________________________________________________________ Date _____________________
Please mail this form and accompanying documents directly to each college/university admission office. Do not mail this form to The Common Application