University of Pittsburgh



2020 – 2021 SAT FEE WAIVER REQUEST FORMPlease email this completed form as an attachment to Frank Revesz at frevesz@pitt.eduPlease Note: This is a form fillable 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 electronically. We encourage everyone to return the form via email as a word attachment. If you are unable to send via email, please type the information an either fax to 717-795-8013 or send US mail to CWRC, Attn: Frank Revesz, 403 E. Winding Hill Rd, Mechanicsburg, PA 17055. Thank you.Today’s Date: FORMTEXT ?????County: FORMTEXT ?????Select Type of SAT Waiver: FORMCHECKBOX Reasoning Test FORMCHECKBOX Subject TestREQUESTOR INFORMATION:(Note: Waivers will not be mailed to students. Waivers will be mailed to the Requestor address)Name: FORMTEXT ?????Phone: FORMTEXT ?????- FORMTEXT ?????- FORMTEXT ????? Ext. FORMTEXT ?????Email: FORMTEXT ?????Requestor Street Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ?????Zip Code: FORMTEXT ?????Notes: FORMTEXT ?????YOUTH INFORMATION:Is youth eligible for Independent Living Services? Yes FORMCHECKBOX (Note: Waivers cannot be issued unless eligible for IL services)First Name: FORMTEXT ?????Middle Initial: FORMTEXT ?????Last Name: FORMTEXT ?????Date of Birth: FORMTEXT ?????/ FORMTEXT ?????/ FORMTEXT ?????Gender: FORMCHECKBOX Male FORMCHECKBOX FemaleYear youth will graduate: FORMTEXT ?????PLEASE CHECK ONLY ONE TEST DATE:TEST DATE: FORMCHECKBOX August 29 FORMCHECKBOX October 3 FORMCHECKBOX November 7Registration Deadline: (July 31) (September 4) (October 7) TEST DATE: FORMCHECKBOX December 5 FORMCHECKBOX March 13 FORMCHECKBOX May 8 FORMCHECKBOX June 5Registration Deadline: (November 5) (February 12) (April 8) (May 6)Comments: FORMTEXT ????? ................
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