Request for CAETR Application Packet

Please complete all the fields on the form below, then click "Done." The next page will display the form for you to print. A non-refundable $50 application packet fee must accompany your application.

Be sure to snail-mail the printed form along with the BCSPR report, the CSRT report, and the application fee.

Send to: LMI ? ATTN: CAETR ? P.O. Box 3326 ? Silver Spring, MD 20918

Full Name:

Street Address:

City:

State:

Phone number: Voice TTY

Email:

BCSPR Score: Date:

CSRT Score: Date: