Fillable Arranged Request For Arranged Testing (ACT, Inc.)

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Arranged Request For Arranged Testing (ACT, Inc.)

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Arranged Testing Policies and Procedures

Eligibility Policy

ACT reviews Arranged testing requests only for examinees who

reside in the United States, US territories, or Puerto Rico, and who

meet one or more of the following conditions:

y The examinee’s religious faith prohibits Saturday testing and a

non-Saturday test center is not scheduled within 75 miles of the

home for any test date during the testing year.

y There is no test center scheduled within 75 miles of the

examinee’s home for any test date during the testing year.

y The examinee is conned to a correctional institution on all test

dates during the testing year.

Note: These are the only conditions ACT will consider for Arranged

testing applicants.

Test Options

There are two test options for the ACT

test:

y The ACT (no writing) is made up of four multiple-choice tests in

English, mathematics, reading, and science.

y The ACT with writing includes the four multiple-choice tests plus

a writing test.

Note: The writing test does not impact the Composite score.

Fees

The test fee covers one report to your high school and up to four

college choices at the time of registration.

Note: See section H of the Request for ACT Arranged Testing for

a list of fees.

Test Accommodations and English Learner Supports

ACT does not provide test accommodations or English learner

supports through Arranged testing. Encourage examinees who

need such arrangements, including those who are homebound or

hospital bound, to request accommodations and/or English learner

supports through Special testing. For information about Special

testing, visit act.org/the-act/accomms.

Deadlines

y Submit the Request for ACT Arranged Testing as early as

possible to provide ample time for review and follow-up

correspondence.

y The request and payment must be postmarked no later than the

deadline for the preferred testing window listed on the request

form.

Response from ACT

y If the request is approved, ACT will ship test materials to

arrive no later than one week prior to the rst day of the testing

window.

y If the request is not approved, ACT will email an explanation or

return the paper request and payment.

y If the request form is missing any information, signatures,

other documentation, or full payment, ACT will not process the

request. ACT will email an explanation.

If an Approved Examinee Does Not Test

Note: Examinees are considered “tested” if they break the seal on

their test booklet or open the booklet.

y Once the examinee is approved, the registration fee is

nonrefundable even if the examinee does not test.

y The following requests will be reviewed only after ACT receives

the unused test materials.

y Examinees who do not test may request the following:

Test Date

Change

To request a test date change, follow these steps:

1. Return the unused test materials to ACT.

2. Compose a written request (signed by both the

examinee and test coordinator) specifying the

new testing window.

3. Submit the written request with payment of the

test date change fee.

Note: The request must be postmarked by the

deadline for the new testing window.

Refund

for

Optional

Services

An examinee may request a refund of the writing

test if they registered and paid for the ACT with

writing and did not take the writing test on test day.

1. Return the unused test materials to ACT.

2. As soon as possible, compose a written

request (signed by both the examinee and test

coordinator) specifying a writing test fee refund.

3. Mail the request with enough time to arrive at

ACT before August 31.

Retesting

ACT requires a new request form, with full payment and any

required documents, each time an examinee wishes to test

through Arranged testing.

How to Contact ACT:

ACT Arranged Testing

301 ACT Drive (PO Box 168)

Iowa City, IA 52243-0168, USA

Office Hours:

8:30 a.m.–5:00 p.m. Central time,

Monday–Friday

Phone: 319.337.1510

Email: Arranged@act.org

Effective July 2019

Arranged Testing Policies and Procedures

Arranged Testing Coordinator

y It is the examinee’s responsibility to ask a teacher or counselor

at the high school, college, or university he or she is currently

attending to serve as the test coordinator.

y If the examinee is not currently attending school, ACT

recommends contacting the testing department at a nearby

college or university.

y The test coordinator must meet all of the following criteria:

1. Be procient in English.

2. Be experienced in administering high stakes testing.

3. Be a staff member of the institution where testing takes

place.

4. Have control over locked, limited-access storage at the

institution to secure the test materials.

5. Agree to administer the tests according to policies and

procedures in the administration manual.

y To protect both the examinee and test coordinator from

questions of possible conict of interest, the following conditions

must also be met. The test coordinator must:

6. Not be a relative or guardian of the examinee.

7. Not be a private consultant or individual tutor whose fees

are paid by the examinee or examinee’s family.

8. Not be engaged in test preparation activities for ACT during

the current academic year.

9. Not be involved in coaching high school or college athletics

(required only if the examinee participates in athletics).

10. Not receive any compensation outside of ACT for

administering the test.

Note: Test scores achieved under the supervision of an individual

who does not satisfy all requirements listed above will be canceled

automatically without refund.

Compensation

y Only the person who administers the tests will be compensated.

y Compensation rates will be sent with the test materials.

y ACT treats all testing staff as independent contractors.

Therefore, wages are not subject to income tax withholding and

Social Security deductions.

y ACT reports the income to the IRS only if payments to an

individual are at least $600 in a given year.

y A payment report form will be sent with the test materials.

Assignment of Test Materials

y Test materials may be used only for the examinee(s) listed on

the Test Materials Distribution List and may not be transferred to

any other examinee or location.

y If the examinee(s) does (do) not test, the test materials must be

returned to ACT immediately with an explanation as to why the

materials were unused.

Answer Documents

y Answer documents are shipped to the test coordinator.

y Examinees enter non-test information and answers to test

questions on the answer document.

y If examinees take the ACT with writing, they complete the

writing essay on another answer document.

y Prior to test day, the test coordinator needs to arrange for

examinees to complete the non-test information, which includes

required identifying information, up to six college choices,

and (optionally) responses to the ACT Interest Inventory and

Student Prole Section.

Scheduling the Administration

y Testing Windows

Arranged testing must be administered in a single session on

one day during one of the designated windows listed on the

request form.

y Testing Time

{ Schedule testing at a time mutually agreeable to the

examinee and test coordinator.

{ Allow an uninterrupted session of approximately 3½ hours

for the ACT (no writing) or 4 hours for the ACT with writing.

{ ACT prefers that testing be scheduled as the rst activity of

the morning.

y Breaks

{ Testing procedures allow a short break after the second test.

{ Examinees taking the ACT with writing will have time to relax

and sharpen their pencils before the writing test.

{ The test session may NOT be interrupted by longer breaks,

for meals, or for other activities. If it is, the answer document

will not be scored or scores will be canceled.

y Test Location

{ Testing must be done at the school.

{ Testing must occur within the United States, US territories, or

Puerto Rico.

{ If the examinee is conned to a correctional institution,

testing must be done at the correctional institution.

Score Reports

y Reports for the ACT (no writing) are normally mailed within 2–8

weeks after ACT receives the answer documents.

y Reports for the ACT with writing are normally mailed within 5–8

weeks.

Effective July 2019

Request for Arranged Testing 2019–2020

General Information

y The test coordinator is responsible for completing this form.

y Incomplete and/or unsigned forms will delay processing.

y Faxed or emailed forms will not be accepted.

y Do not register or pay through your ACT student web account.

A. Examinee Information (print or type)

Name (Last, First, Middle Initial) Date of Birth ACT User ID (if available)

Street Address or PO Box (if not available, use school address)

City State ZIP Code

Email Address 10 Digit Phone Number

High School / College (if currently attending) High School Code (if currently attending)

B. Test Coordinator Information (print or type)

Name (Last, First, Middle Initial) Title

School Name (attach explanation if not the examinee’s school)

Street Address of School (required for shipping materials) PO Box

City State ZIP Code

Email Address (required) 10 Digit Daytime Phone Number

C. Testing Window (select one)

y Mark only one testing window.

y Send this request no later than the deadline for the selected

testing window.

Testing Window Postmark Deadline

 September 14–29, 2019 August 16

 October 26–November 10, 2019 September 20

 December 14–29, 2019 November 8

 February 8–23, 2020 January 10

 April 4–19, 2020 February 28

 June 13–28, 2020 May 8

 July 18–August 2, 2020* June 19

*No test centers are scheduled in California or New York for the

July test date.

D. Test Option (select one)

 ACT (no writing)

 ACT with writing

E. Reason for Arranged Testing

Check one and include any required documentation.

 (04) Religious faith prohibits Saturday testing and no

non-Saturday test center scheduled for any test date

during the testing year within 75 miles. Include

a letter from a cleric (not a relative) or a notarized

statement to verify the prohibition.

 (08) No test center scheduled for any test date during the

testing year within 75 miles.

 (10) Conned to a correctional institution from September

2019 through July 2020.

Confidential. Restricted when data present.

Effective July 2019

F. Test Coordinator’s Statement

I certify that I have read and understand the Policies for ACT Arranged Testing. I further certify that I personally meet all requirements to

be a test coordinator as speci

ed in the Policies for ACT Arranged Testing and that I, or a member of my staff who also meets the same

requirements, will administer the tests in accordance with the ACT Administration Manual sent with the test materials. I will ensure

that the test materials are kept secure and condential, used only for the examinee identied on this form, not transferred to another

individual or location, and returned to ACT immediately after testing. I understand that by agreeing to be a test coordinator, I consent to

the ACT Privacy Policy (act.org/privacy.html), which is incorporated into these Policies for ACT Arranged Testing by reference,

including consent to the collection of my personally identifying information and its subsequent use and disclosure.

Signature Date

G. Examinee Statement

I certify that I am the person whose information is submitted in accordance with the Policies for ACT Arranged Testing on this form and

in the attached documentation, if any, and that the information provided is true and accurate to the best of my knowledge. I understand

that by submitting this form, I consent to the ACT Privacy Policy (act.org/privacy.html), which is incorporated into these Policies for

ACT Arranged Testing by reference, including consent to the collection of personally identifying information and its subsequent use and

disclosure. Without limiting the above statement, I specifically authorize the release to ACT of diagnostic information by school officials,

physicians, or others having such information, and full documentation, if requested. I understand that any documentation provided to

ACT will remain with the application and will not become part of my examinee score record.

Examinee’s Signature (Parent or guardian must also sign if examinee is under 18.) Date

H. Fees

y Payments must be in the form of a check* or money order payable to ACT in US dollars and drawn on a United States or US afliate

bank.

y If eligible, examinees may pay with a fee waiver.

Description Fee

ACT (no writing) $52.00

ACT with writing $68.00

**Late Request $30.00

Test Date Change $32.00

Test Center Change $32.00

*This is notication that when you pay by check you are authorizing ACT, Inc., to convert your check to an electronic entry. When we

use this information from your check to make an electronic funds transfer, funds may be withdrawn from your account as soon as the

same day you make your payment, and you will not receive your check back from your nancial institution. If your check is returned to

us due to insuf

cient or uncollected funds, it may be re-presented electronically and your account will be debited.

**A late fee is required for requests postmarked after the postmark deadline. Late requests will be processed for the preferred test date

only if the late fee is included and if the request is received before the National test date’s late registration deadline.

Note: Visit

actstudent.org for National test dates and registration deadlines.

I. Return of Request Form.

Detach and mail this completed form, all required supporting documentation, and payment to:

ACT Arranged Testing

301 ACT Drive (PO Box 168)

Iowa City, IA 52243-0168

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