Certified Test Administration Site Application Form

To apply for the Certified Test Administration Site (CTAS) program, please complete this online form. If you are responding to an e-mail or other correspondence from ETS, please include your Reference ID to expedite the application process.

Note that fields marked with an * are required.

Individual Profile

Reference ID	(if provided by ETS)
Prefix	(Mr., Mrs., Ms., etc.)
First Name:	*
Last Name:	*
Suffix:
Job Title:	*
Department:	*

Contact Information

E-mail Address:	*
Phone number with area code:	*
Fax Number with area code:	*

Job Responsibilities

*Please indicate your role in deciding whether your organization may participate in an ETS Certified Education Partner program.

I am the decision maker   I am one of the decision makers   I make recommendations to the decision maker(s)   I am not involved in the decision making

If you are not the sole decision maker, who else would be involved in determining your participation?

Name:
E-mail Address:

Organization Information

Test Site Reporting Address:

P.O. Boxes are not acceptable.

Country	*
Institution:	*
Address 1:	*
Address 2:
Address 3:
City:	*
State/Province:
Zip/Postal Code:	*

Organization Type

*Organization Type

Select OneUniversity/CollegeHigh SchoolEnglish Language School/Test PreparationCommerical Testing CenterOther

Test Site Shipping Address:

*Is Shipping Address the same as Reporting Address?

Yes   No

Country
First Name of Person to ship to:
Last Name of Person to ship to:
Institution:
Shipping Address 1:
Shipping Address 2:
Shipping Address 3:
City:
State/Province:
Zip/Postal Code:

Background Information

*What are the advantages to ETS test takers to have a test center at your location?

*Does your organization have any affiliation with ETS or an ETS affiliated organization?

Yes   No

If yes, please describe:

*Please provide references such as educational accreditation status by a government organization, official educational accreditation agency or membership association.

*How many years has your organization been in operation?

years

*How many years has your organization been at your current location?

years

If available, please provide the URL for your institution/organization.

Available Internet-Based Tests

Which Internet-Based Test(s) are you interested in administering at your site? (Check all that apply.)

TOEFL   Texas Examination of Educator Standards (FOR TEXAS ONLY)   PRAXIS (US ONLY)

Operational Profile

To conduct Internet-based tests, you will need to provide a secure room for approximately a 6-hour block of time.

TOEFL iBT tests are typically administered on Fridays, Saturdays and Sundays. TExES and PRAXIS tests are administered Monday through Saturday.

*How many secure rooms with computers do you have available for ETS test administrations? (Up to 3)

How many computers are available in each lab?

Lab 1:	*
Lab 2:
Lab 3:

Start Date

On what date could you begin participating in ETS test administrations?

Month:

Select OneJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Day:

Select One12345678910111213141516171819202122232425262728293031

Year:

Select One201220132014

If you encounter difficulty submitting this form, please print and fax it to 609-406-5360.