Scsep Third Party Attestation Forms - U.s. Department Of Labor Page 7

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Third-Party Attestation Form for Item P24
Low literacy skills?
On this date, I attest that __________________________________________
(Name of Applicant)
has low literacy skills, that is:
_____ the applicant computes or solves problems, reads, writes, or speaks at or below the 8th
grade level; or
_____ the applicant is unable to compute or solve problems, read, write, or speak at a level
necessary to function on the job, in the individual’s family, or in society.
Specific information about your relationship to the applicant and an explanation of how you are in a
knowledgeable position to attest to the facts cited above is required. Please provide this information
below (Note: Use the back of this form if additional space is needed):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_____________________________________
_____________________________________
(Name of Attesting Individual)
(Relationship of Attesting Individual to Applicant)
_____________________________________
___________________
(Signature of Attesting Individual)
(Date)
SCSEP Third Party Attestation Forms
page 7 of 12

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