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SIMR 2014 Application Fee Waiver Form: Student Name: Student Email Address: Street Address: (If the student?s family income is less than $60,000, this form does not need to be filled out. The fee will automatically be waived.) ----------------------------------------------------------------------------------------------------------------------------- Authorized Official (High School counselor, teacher, community leader) Name: Email: Phone #: High School: Official Title: Signature (electronic signature is ok): ? Economic Need (to be filled out by the authorized official above): Request from high school principal, high school counselor, financial aid officer, or

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