U.S. citizens or permanent residents who demonstrate financial need, or who are current or recently-separated (within last six months) participants in public service programs (i.e., Peace Corps, Teach for America, AmeriCorps), or who are active or recently-separated members of the military, are eligible for a waiver of the application fee. To request a waiver, please complete this form and submit it with the required supporting materials as soon as possible and no later than 5 pm, January 15, 2013.

LSAC Number

Name (First, Middle, Last) (required)
Select One Mr Ms Mrs

Program Name
Select One Americorps Teach for America Peace Corps McNair Scholar Program National Consortium for Graduate Degrees for Minorities in Engineering & Science Program U.S. Military

Date of the last day of your program

Program Verification Documentation

- OR -

I have been approved for the LSAC fee waiver for the 2012-2013 cycle

LSAC Waiver Approval Letter

- OR -

I am applying due to financial hardship.

Signed Financial Hardship Petition Letter

Supporting Documentation of Hardship

I understand that my application fee may be waived based on the information that I have provided. I certify that all the information I have provided is true and complete.

Please print full name as signature