Rev 10/11/19 jmk
P L A C E M E N T T E S T F E E W A I V E R R E Q U E S T F O R M
The purpose of this form is to request to have your placement test fee waived. Placement test fee waivers are subject to
approval based on evidence of financial need or as approved by a WVC Counselor. An approved placement test fee
waiver is valid for one testing session only. If you wish to retest later, you must pay or request a new waiver. A request
of a waiver does not mean that it will be granted. If the waiver request is not granted, you are responsible to pay the
placement test fee before you will be allowed to test.
1. You must have applied for admission to WVC and received a Student ID number (SID).
2. Return this completed form to your campus:
Wenatchee: the Educational Planning & Testing Center on the first floor of Wenatchi Hall or email it to
email@example.com (subject line “Fee Waiver”)
Omak: the front desk in the Administration Building or email it to firstname.lastname@example.org or email@example.com
(subject line “Fee Waiver”)
3. WVC Placement staff will process your request within seven business days. Placement staff will contact you to
let you know if your request was approved or denied and to schedule your test.
Last First Middle
Student ID ________________________________________________ Date of Birth _______________________
Email ____________________________________________________ Phone ____________________________
Demonstration of Financial Need (mark any that apply)
Have you submitted a Free Application for Federal Student Aid (FAFSA) or a Washington
Application for State Financial Aid (WASFA) and received a Student Aid Report (SAR) showing a
zero Estimated Family Contribution (EFC) or Pell Grant eligibility?
Does your family receive public assistance (Food Stamps, Welfare, SSI, TANF, GAU, etc.),
Working Connections Childcare, medical coupons from the state, WIC Coupons, or
Do you or your children qualify for free and reduced lunch from your school district?
Do you live in Section 8 or subsidized public housing, foster home, or are homeless?
Are you a dependent or ward of the court, an orphan, or unaccompanied youth?
Do you have approval from a WVC Counselor for a test fee waiver? WVC Counselor’s signature required.
I grant the above student a placement test fee waiver: _________________________________
WVC Counselor Signature
I certify that I understand and meet eligibility requirements to request a placement test fee waiver.
Student Signature _______________________________________________________ Date _________________
Office use only Approve Deny Student contacted? Initials __________ Date __________
Wenatchee Valley College is committed to a policy of equal opportunity in employment and student enrollment. All programs are free from discrimination and harassment against any person because of
race, creed, color, national or ethnic origin, sex, sexual orientation, gender identity or expression, the presence of any sensory, mental, or physical disability, or the use of a service animal by a person with
a disability, age, parental status or families with children, marital status, religion, genetic information, honorably discharged veteran or military status or any other prohibited basis per RCW 49.60.030, 040
and other federal and state laws and regulations, or participation in the complaint process. The following persons have been designated to handle inquiries regarding the non-discrimination policies and
Title IX compliance for both the Wenatchee and Omak campuses: To report discrimination or harassment: Title IX Coordinator, Wenatchi Hall 2322M, (509) 682-6445, firstname.lastname@example.org. To request disability
accommodations: Student Access Director, Wenatchi Hall 2133, (509) 682-6854, TTY/TTD: dial 711, email@example.com.