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Get 2011-12 Medical/dental Expense Form (independent Student - PHEAA - Pheaa

L EXPENSE FORM (INDEPENDENT STUDENT) (NOTE: Deadline for returning this form and 2010 tax documents to PHEAA is April 1, 2012.) Print Student s Name Student s Account Number OR Student s Social Security Number 2011-12 The Agency may permit reconsideration of an application if your family paid extraordinary unreimbursed medical/dental expenses during 2010. You should provide the requested information regarding family medical/dental expense.

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