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WAIVER APPLICANT VERIFICATION FORM COMMUNITY PATHWAYS A. B. Individual: 1. Soc. Sec. No: Placement from an SRC/SETT/Nursing or State Hospital Facility: Discharge Date: Transitioning Youth ? Fiscal
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01
Begin by carefully reading the instructions provided on page 1 of the waiver applicant form.
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Fill in your personal information accurately and legibly. This may include your full name, address, phone number, email, and any other required contact details.
03
Provide your date of birth, as well as your gender, if requested.
04
If applicable, enter your social security number or any other identification number requested.
05
Indicate the purpose or reason for requesting the waiver by providing relevant details in the designated section. This could be related to a specific program, event, or circumstance that requires the waiver.
06
If there are any applicable dates or timelines associated with the waiver, make sure to fill them in accurately.
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Review the form for any additional information or sections that require your input. These may include questions about your previous criminal record, medical history, or other relevant details.
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Sign and date the form, confirming that the information provided is true and accurate to the best of your knowledge.
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Keep a copy of the completed page 1 waiver applicant for your records.
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The page 1 waiver applicant form is typically required by individuals who are seeking an exemption, permission, or special consideration. The specific requirements or circumstances that necessitate the form will vary depending on the situation. It is crucial to consult the organization or entity that is requesting the waiver to determine whether page 1 waiver applicant is needed and what specific information is required.
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