2016-2017 Missouri Content Assessment Voucher Request Form
Eligibility for a Missouri Content Assessment Voucher is dependent on financial need as demonstrated through the Free Application for Federal Student Aid (FAFSA) for the 2016-2017 academic year. Students who are not currently enrolled must still file a FAFSA for 2016-2017 to determine eligibility. Please attach your FAFSA confirmation page or first page of your 2015-2016 Student Aid Report (SAR) including the primary EFC information, which must be $1,200.00 or less. Fax completed Missouri Content Assessment Voucher forms to Kathleen Wendt at 314.744.7656 or scan and email to .
DATE: Click here to enter text.CLASSIFICATION: ☐FR ☐SO ☐JR ☐SR ☐PBC ☐MAT
FULL NAME: Click here to enter text.STUDENT ID NUMBER: Click here to enter text.
SOCIAL SECURITY NUMBER:Click here to enter text.Are you an F-1 International Student? ☐Yes ☐No
CURRENT ADDRESS:Click here to enter text.
Street AddressCity, State Zip Code
CURRENT TELEPHONE: Click here to enter text.EMAIL ADDRESS: Click here to enter text.
Projected year and semester of graduation/completion: Click here to enter text.
Check One: ☐BA ☐BME ☐BPS ☐BS ☐BSE ☐Post-Baccalaureate Certification ☐MAT
MAJOR:Click here to enter text.MINOR:Click here to enter text.ADVISOR: Click here to enter text.
Anticipated student teachingsemester:☐Fall☐SpringYear Click here to enter text.
Certification Area(s) (check all that apply):
☐Early Childhood, Birth-Grade 3☐Early Childhood Special Education, Birth-Grade 3☐Elementary, 1-6
☐*Middle School, 5-9: Click here to enter text.☐*Secondary Education, 9-12: Click here to enter text.☐*K-12:Click here to enter text.
*Middle School, Secondary, and K-12 must select a subject field from the following list (please place the corresponding letter in the blank above):
a. Business Education; b. English/Language Arts; c.Health; d.Library Media Specialist; e.Mathematics;
f.Music–Vocal/Choral; g.Music–Instrumental; h.Physical Education; i.Social Science; j.Speech/Theatre;
k.Unified Science–Biology; l.Unified Science–Chemistry; m. Categorical Biology; n. Categorical Chemistry;
o. Categorical General Science; p. Special Education: Cross-Categorical Disabilities: Mild to Moderate
We have a limited number of vouchers available. Applications will be considered in the order in which they are received. Students may receive only one voucher. Vouchers will cover part, but not all, of the registration fee. Priority will be given to those who must take multiple exams or exams with multiple subtests (cross-categorical disabilities, elementary education, secondary social science, unified science biology or chemistry, etc.).
Vouchers are not available for certification area(s) which you are seeking to add via exam.