Northwest High School
COLLEGE TESTING FEE WAIVER REQUEST FORM
COLLEGE TEST WAIVERS ARE AVAILABLE FOR THE FOLLOWING COLLEGE
TESTS: ● SAT ● SAT Subject Tests
● ACT
● TOEFL
RETURN FORM TO THE COLLEGE-CAREER INFORMATION CENTER
STUDENT ID: ___________ STUDENT NAME: _____________________________________________________
STUDENT GRADE: ________ Are you a US CITIZEN OR PERMANENT RESIDENT? Yes or No (please circle one)
GENERAL FEE WAIVER INFORMATION (Please read carefully):
The ACT, the TOEFL Program and the College Board Program for the SAT offer a fee-waiver service to assist students in the
payment of fees for these college testing programs. Students are eligible for fee waivers in their JUNIOR or SENIOR year
only with exception of the SAT Subject Tests which are now available as early as the freshman year and TOEFL which
requires senior year registration. THIS FORM IS CONFIDENTIAL AND FOR SCHOOL USE ONLY. In addition, acceptance
of the any fee waiver is with the stipulation that you will be present to take the test on test day.
SAT: Students can receive up to FOUR FEE WAIVERS (2 for the SAT and 2 for SAT Subject Tests). Each SAT Subject Test
fee waiver covers up to three SAT Subject Test fees for each registration. When you use SAT Program fee waivers, you also
qualify to waive up to four college application fees. College Board college application fee waivers will be delivered online to
eligible students once the student has registered using a College Board fee waiver code. For more information on college
application waivers visit https://sat.collegeboard.org/register/sat-fee-waivers. The College Board SAT waiver covers 100% of the
cost of registration, including up to 4 score reports with each test registration.
ACT: Eligible students can receive up to TWO FEE WAIVERS in either the junior OR senior year. The waiver counts as
used once you register, even if you do not test on the requested date. Waivers cover only the cost of the basic registration
fee. Not included are late registration fee, test date or test center changes, standby fees or additional score reports (4 score
reports are included with your use of the waiver at the time of registration).
TOEFL: Eligible students may REGISTER ONLY ONCE in their SENIOR year with the REDUCED VOUCHER that covers
one-half of the TOEFL registration fee. At form publication full registration fee for the TOEFL is $190. Current registration fee
information is available on the TOEFL web site at www.ets.org/toefl.
ELIGIBILITY GUIDELINES:
For fee waiver eligibility, the student must be a US citizen or permanent resident testing in the United States and the student must
meet one or more of the following requirements. Please indicate your eligibility below:
____ Student is eligible for the free or reduced lunch program.
____ Family receives assistance under Part A of Title IV of the Social Security Act.
____ Student is eligible to receive medical assistance under the Medicaid Program under Title XIX of the Social Security Act.
____ Student is a member of a family whose taxable income for the preceding year falls within the guidelines stipulated on the
chart below.
____ there is financial need due to individual hardship that can be documented in writing by the school counselor.
____________________________________________________
Counselor Signature
Date
Income eligibility guidelines based on USDA Food & Nutrition Service Income Eligibility Guidelines*
Number of Members in Household (incl. head of household)
1
2
3
4
5
6
Total Annual Income (preceding calendar year)
$21,978
$29,637
$37,296
$44,955
$52,614
$60,273
6+ add $7,696 for each additional household member
I, as the parent/guardian of the above named student, certify by signature below that this student qualifies for a
college testing fee waiver based on the above guidelines. ELIGIBILITY DOCUMENTATION MUST BE ON FILE AT
THE HIGH SCHOOL.
________________________________________________________________
Signature of Parent or Guardian
Date
College/Career Center; Fee WAIVER Info; Application for Waiver of Fee.doc (*updated for 2016-2017)
Revised 29-Jul-16; Staff completes side 2 of form
Fee Waiver Applicant: DO NOT WRITE IN THE AREA BELOW
Fee Waivers Issued:
SAT Test
SAT Test Date(s)
Date Waiver Provided to Student
Waiver Code
1.
2.
SAT Subject Test
Subject Test Date(s)
1.
Date Waiver Provided to Student
Waiver Code
2.
ACT
ACT Test Date(s)
Date Waiver Provided to Student
Waiver Code
1.
2.
TOEFL
Date TOEFL Check Request to Business Office (if needed):
Date TOEFL Waiver Reduction Request Submitted (mailed):
Fee Waiver Applicant: DO NOT WRITE IN THE AREA ABOVE
College/Career Center; Fee WAIVER Info; Application for Waiver of Fee.doc (*updated for 2016-2017)
Revised 29-Jul-16; Staff completes side 2 of form