Order Form for ACT
®
Alternate Format Practice Tests
Use this form to place an order for free alternate formats of the ACT practice test.
Instructions
1. Order the practice test format(s) that your students/you will require for the ACT administration by indicating the
quantity of each item in the rst column.
2. Email the completed form to act-services@act.org.
Please consider quantities carefully. You may reuse these materials.
Quantity Item Description Identier
Pre-recorded Audio (USB)
Includes a regular-print test booklet and USB
Usage Guidelines.
01136622KT
Braille (with Raised Line Drawings—
EBAE)
Includes a regular-print test booklet.
01117722PT
Braille (with Raised Line Drawings—
UEB with Nemeth)
Includes a regular-print test booklet.
01117A22PT
Braille (with Raised Line Drawings—
UEB Math/Science)
Includes a regular-print test booklet.
01117C22PT
Braille Writing Booklet (EBAE)
For braille users taking the ACT with writing.
01117722W
Braille Writing Booklet (UEB)
For braille users taking the ACT with writing.
01119922W
Raised Line Drawings (EBAE) For use only by students requiring oral
presentation. If you choose braille, do not order
this item.
01117322PT
Raised Line Drawings (UEB with
Nemeth)
For use only by students requiring oral
presentation. If you choose braille, do not order
this item.
01117K22PT
Raised Line Drawings (UEB Math/
Science)
For use only by students requiring oral
presentation. If you choose braille, do not order
this item.
01117F22PT
Large Print Multiple-Choice Booklet Includes a large-print (18-pt.) answer document. 011AK1220
Large Print Writing Booklet
Large-print (18-pt.) writing booklet
01195822W
A copy of Preparing for the ACT
®
Test Special Testing will be included with each set of items ordered. This publication provides
the scoring keys and a writing test, which may be read verbatim to students.
Ship to: (Type or print; all elds required unless stated otherwise.)
______________________________________________________________________
Name and Title (if applicable)
______________________________________________________________________
Institution Name (If applicable; if not, check box below.)
■ I am ordering as an individual (e.g., as a parent), not for a school.
______________________________________________________________________
Address (Do not use PO Box number.)
______________________________________________________________________
City State ZIP
______________________________________________________________________
Telephone (Include area code and extension.)
______________________________________________________________________
ACT Customer Number (if known)
___ ___ ___ ___ ___ ___ ___ ___ ___ ___
High School Code OR College Code (if applicable)
For questions related
to tracking an order,
please email ACT at
act-services@act.org.
For all other inquiries
regarding testing
students with disabilities,
please contact ACT Test
Accommodations at
319.337.1332.
© 2021 by ACT, Inc. All rights reserved.
FR00003.CJ08785
