ADVANCED PLACEMENT PROGRAM

2012 AP Exam Fee Waiver Application Form

 

          The Maryland State Department of Education has entered into a fiscal contract with the Federal Government Grant Program and The College Board, allowing public and private schools to provide AP exam fee waivers for students who meet eligibility requirements based on family income.  A limited number of fee waivers have been made available to students in Howard County Public Schools.  Because the number is limited, it is important that you apply as soon as possible.

 
          If you meet one or more of the guidelines listed below, complete and this form, attach it to your Registration Form and submit both forms before your registration deadline.  Because of limitations placed on the state grant, The College Board has recommended that individual students pay $15 for up to three exams, and $53 for each additional exam.  Howard County schools, however, will be providing supplemental support to allow registration at a cost of $15 for each exam, regardless of the number of exams the student selects.  Please contact your school-based AP Coordinator if you need additional support or have any questions regarding fees at your school.
 

THE INFORMATION PROVIDED ON THIS FORM WILL REMAIN CONFIDENTIAL

 
Name of Student _______________________________________________________
Please check the appropriate item or items to indicate your student's eligibility:
_______ My student is eligible for the free or reduced lunch program.

_______ My family receives assistance under Part A of Title IV of the Social Security Act.

_______ My student is eligible to receive medical assistance under the Medicaid Program under title XIX of the Social Security Act.
_______ My student is a member of a family whose taxable income for the preceding year did not exceed 185% of the poverty level as established by the US Census Bureau.  The table below lists family incomes, by family size at 185% of the poverty level.

INCOME ELIGIBILITY GUIDELINES
Household Size Family Income (not to exceed these amounts)
Year Month Week
1 $20,036 $1,670 $385
2 26,955 2,246 518
3 33,874 2,823 651
4 40,793 3,389 784
5 47,712 3,976 918
6 54,631 4,553 1,051
7 61,550 5,129 1,184
8 68,469 5,706 1,317
For each additional person add... $ 6,919 $577 $133
Parent Name (please print) ________________________ 

Parent Signature _________________________  Date __________________