Financial Hardship Award Application
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First Name: *
Last Name: *
ARDC # *
Email Address: *
Mailing Address:  *
City: *
State:
Zip Code: *
Phone Number:  *
Program Title *
Program Date (if applicable):      
MM
/
DD
/
YYYY

Program Location (if applicable):

Desired Participation Format:  *
Minimum Eligibility for Consideration

Please confirm that you meet all of the following minimum requirements for consideration.

Evidence of Financial Hardship. 
Please check all that apply. However, you are only required to check one item below in order to have your application considered. 

Please provide a written description of the circumstances that lead you to apply for a tuition waiver. 

Please note that IICLE may contact you to request more information after initial review of your application.  
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