ACT Fee Waiver Request Form
The ACT provides a total of four fee waivers to 11th or 12th grade students who are considered economically disadvantaged.

To qualify, you must meet one of the following indicators below of economic need:
-Enrolled in free- or reduced- price lunches
-Enrolled in a program for economically disadvantaged, such as Gear Up or Upward Bound
-Reside in a foster home, be a ward of the state, or be homeless
-Family receive low-income public assistance (such as SNAP EBT) or live in federally subsidized public housing
-Family's total income is at or below the USDA Federal Guidelines (site for income limits found at the PDF below)

To view eligibility information in its entirety or get more information, please visit: https://www.act.org/content/dam/act/unsecured/documents/FeeWaiver.pdf

Disclaimer: You may fill this form out at any time but it will only be checked during regular school hours following our school's calendar. PLEASE USE YOUR SCHOOL EMAIL. 
Sign in to Google to save your progress. Learn more
Email *
Please check which of the criteria you meet or believe you meet. This information is kept confidential. (To get further information about each of these criteria or to view the USDA income limits, visit the PDF linked above in the description box) *
Required
Please sign your name below. *
Grade *
A member of our Guidance team or Administration will check this form and verify your eligibility. If you qualify, we will send you an ACT voucher through your @dcchoctaws email or we may call you into our office to receive a paper copy. Please email dchscounselor@dcchoctaws.net if you have any questions. Do you understand that you will need to check your email and that you may receive the voucher electronically? *
Please check your email!
If you still have questions email dchscounselor@dcchoctaws.net 
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Dyer County School District. Report Abuse
Google Forms