Sign Language Interpreter Certication
Interpreter—Follow the steps below to complete this form. Sections 1, 2, and 3 must be
completed prior to the test administration. All information is required.
Test Coordinator—Return this completed form inside the Test Administration Forms Envelope
on test day. If it is not submitted on test day, return to:
ACT Test Administration (58) Phone: 319.337.1510
PO Box 168 Fax: 319.339.3039
Iowa City, IA 52243-0168 Email: firstname.lastname@example.org
1. Print the administration information:
Examinee’s Name Test Date
Test Center Name Test Center Code Room Name/Number
2. Read the interpreter policies and responsibilities:
Thank you for helping ACT provide an equitable testing opportunity for this examinee.
The following information describes the governing policies and your test day role and
You may not be a relative or guardian of the examinee. If a relative or guardian
interprets for the examinee, the examinee’s tests will not be scored or the scores will
Comply with standardized testing polices, as directed by test center staff.
Accompany the examinee into the test room and remain with the examinee
throughout the administration.
Interpret all verbal instructions and communications made by staff. Interpret any
questions from examinees to the staff and the staff’s responses to those questions.
Do not interpret any test content.
Do not answer questions about the verbal instructions or test content. If the
examinee has questions, ask a member of the testing staff for the answer.
Do not eat, drink, or use electronic devices of any kind, including cell phones, in the
test room. All electronic devices must be powered off. You may bring snacks and
beverages to consume outside the test room during break.
3. Sign the Interpreter’s Certiﬁcation Statement:
I certify that I am not related to or the guardian of the examinee named above; I interpreted
the verbal instructions for the examinee named above in accordance with the policies stated
above; and I provided no assistance to the examinee with regard to test content.
Interpreter’s Name (print) Signature Date
4. Have the room supervisor sign the Room Supervisor’s Certiﬁcation Statement:
I certify that the individual named above interpreted the verbal instructions and complied
with standardized testing procedures under my supervision.
Room Supervisor’s Name (print) Signature Date
5. If requesting payment, complete the Sign Language Interpreter Request for Payment (page 2)
6. Give this form to the test coordinator at the end of testing, even if you are not requesting payment.