Admission Fee Waiver Form - Agency

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Admission Fee Waiver Form - Agency _______________________________

__________________________

Print Student’s Name (First & Last)

Print Student’s Date of Birth (xx/xx/xxxx)

is a client of ____________________________________________________. Print Agency Name

Paying the $45 Application Fee to Thaddeus Stevens College of Technology would be a hardship for this student. I am requesting a waiver of the Application Fee for this student.

_______________________________________________________________ Print Agency Representative’s Name & Title

_________________________________

___________________________

Agency Representative’s Signature

Date

____________________________ Agency Representative’s Telephone Number

2019_2020