Fillable Form 202122: The Praxis Tests and (ETS)

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Form 202122: The Praxis Tests and (ETS)

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2021–22
The Praxis
®
Tests and
School Leadership Series Assessments
Bulletin Supplement
for Test Takers with Disabilities
or Health-Related Needs
NOTE: This supplement contains procedures and forms for requesting
accommodations for the tests listed above.
Use this supplement together with the information and registration form(s)
found in the Praxis and SLS Information Bulletins and/or on each testing
program’s website, at www.ets.org/praxis and www.ets.org/sls.
Visit the E T S website at www.ets.org/disabilities
for the most up-to-date information.
Praxis/SLS Bulletin Supplement for Test Takers with Disabilities or Health-Related Needs
CONTACT INFORMATION
All questions related to accommodations should be directed to ETS Disability Services.
ETS Disability Services
Monday – Friday 8:30 a.m. – 5 p.m. U.S. Eastern Time (New York)
Phone: 1-866-387-8602 (toll-free in the U.S., U.S. Territories and Canada)
1-609-771-7780 (all other locations)
General Email
Inquiries: stassd@ets.org
Mail: ETS Disability Services
PO Box 6054
Princeton, NJ 08541-6054 U.S.A.
Courier Service: ETS Disability Services
225 Phillips Boulevard
Ewing, NJ 08628-1426 U.S.A.
2
TABLE OF CONTENTS
Contact Information .................................................................................................................................. 2
General Information .................................................................................................................................. 4
Steps to Request Accommodations ............................................................................................................. 5
Step 1: Complete the Testing Accommodations Request Form.................................................. 5–6
Step 2: Complete Praxis or SLS Test Authorization Voucher Request Form ................................... 7
Step 3: Gather Your Disability Documentation ............................................................................. 7
Step 4: Submit Your Completed Forms and Documentation to
ETS Disability Services .............................................................................................................. 8–9
Changing or Cancelling a Test ................................................................................................................... 9
Praxis or SLS Test Preparation................................................................................................................. 9
Score Reporting......................................................................................................................................... 9
Testing Accommodations Request Form
Part I – Applicant Information ...............................................................................................
....................................................................................
............................................
..........................................................................................
..................................................................................
10–15
Part II – Accommodations Requested 16–17
Part III – Certication of Eligibility: Accommodations History 18–22
Test Authorization Voucher Request Form 23–25
SLS Test Authorization Voucher Request Form. 26–28
Copyright © 2021 by Educational Testing Service. All rights reserved.
ETS, the ETS logo, MEASURING THE POWER OF LEARNING, GRE, TOEFL, TOEFL iBT,
and PRAXIS are registered trademarks of Educational Testing Service (ETS) in the United States and other countries.
All other trademarks are property of their respective owners.
Praxis/SLS Bulletin Supplement for Test Takers with Disabilities or Health-Related Needs
GENERAL INFORMATION
ETS is committed to serving test takers with disabilities or health-related needs by providing reasonable
accommodations that are appropriate given the purpose of the test.
While many test takers with disabilities successfully take the Praxis or School Leadership Series Assessment
(SLS) with appropriate accommodations, some test takers with disabilities may want to ask their prospective
institution or fellowship sponsor whether it is willing to waive the test requirement and consider their
application based on other information.
Important: Test takers requesting accommodations MUST complete a Testing Accommodations Request Form
and submit it to ETS Disability Services. The form may be submitted online, via email, mail or courier service.
We strongly encourage using the convenient online registration system. You must submit your request and have
your accommodations approved by ETS Disability Services before your Praxis or SLS test may be scheduled.
Accommodations cannot be applied to a test that has already been scheduled.
Submit your request as early as possible. Documentation review takes approximately four to six weeks once
your request and complete paperwork have been received at ETS. If additional documentation is requested,
it may be approximately two to four weeks from the time the new documentation is received until the review
is complete. ETS is committed to producing alternate test formats as quickly as possible; however, production
times may vary.
Information about Praxis or SLS program policies, tests offered, test dates, fees and payment policies,
identication (ID) requirements, test center procedures and score reporting information is available in
the Praxis or SLS Information Bulletin and on the Praxis or SLS website at www.ets.org/praxis or
www.ets.org/sls. It is recommended you review this information prior to requesting accommodations.
To submit your accommodation request online, you will need to create an ETS account. Praxis test takers can
go to https://www.ets.org/praxis; and SLS test takers can go to https://www.ets.org/sls. In your ETS account
you may upload documentation and indicate your preferred test date and location. You may also view your
approved accommodations and test appointments. In addition, if you are approved for extended test time, extra
breaks, screen magnication and/or selectable background and foreground colors, you may also self-schedule
your test online through your ETS account. If you are requesting and are approved for accommodations other
than the four listed above, you cannot schedule your test online. Your approval letter will provide instructions
for scheduling your test.
Using Previously Approved Accommodations
If you were previously approved for accommodations on a Praxis or SLS test, review your approval letter to
determine if your accommodations approval is still current. If your accommodations have not expired, you
may register following the directions on your letter.
If you are registering for a paper-based test, complete Parts I and II of the Accommodations Request Form
and the Registration Form even if you are requesting accommodations identical to those approved for you by
ETS within the last two years.
If you have received accommodations from ETS for another test (for example, the TOEFL
®
test, GRE, or
GACE assessment) and your documentation is still current, you may request the same accommodations
for a Praxis or SLS test during the 2021–22 testing year without providing disability documentation. The
accommodations ETS previously approved for you will be approved again if they are appropriate for the
current test.
4
Praxis/SLS Bulletin Supplement for Test Takers with Disabilities or Health-Related Needs
Reduced-distraction Setting
Many test takers request a reduced-distraction setting. The testing centers are designed to have minimal
distractions with each test taker assigned to an individual carrel with earplugs or headphones available upon
request to further reduce environmental noise.
Pre-approved Personal Items
Certain items are allowed in the testing environment without prior approval. These include, but are not
limited to, bandages, spinal cord stimulators, foot stool, lumbar support cushion, service animals and
hearing aids/cochlear implant. However, if your hearing aids or cochlear implant have Bluetooth capabilities,
accommodations must be requested. The full list of pre-approved personal items is available for use at test
centers or for at-home testing at www.ets.org/disabilities/prometric.
If you wear an insulin pump, you do not need to request accommodations unless your pump consists of two
pieces (the pump which is attached to your body plus the transmitter used to program the pump) or your
pump is especially noisy. If the pump cannot be silenced and is likely to disturb other test takers, requesting
accommodations is a good idea so you may be scheduled in a separate room. A continuous glucose monitor
attached to your pump does not require prior approval; however, if you wish to bring your glucose test kit into
the testing room, you must request accommodations.
Steps to Request Accommodations
To request accommodations for a Praxis or SLS test, follow the steps below:
1. Complete the Testing Accommodations Request Form.
2. Complete the Praxis or SLS Test Authorization Voucher Request Form (if not submitting your
materials online).
3. Gather your disability documentation.
4. Submit completed forms.
Detailed information regarding each of these steps is provided in this Supplement.
STEP 1: Complete the Testing Accommodations Request Form
Complete the Testing Accommodations Request Form on pages 10–22 in this Supplement or access and
complete the form in your ETS account. Praxis test takers can go to https://www.ets.org/praxis; and SLS
test takers can go to https://www.ets.org/sls.
Part I — Applicant Information
Complete this section and sign the Applicant’s Verication Statement even if you are requesting
accommodations identical to those approved for you by ETS within the last two years.
Part II — Accommodations Requested
Complete this section even if you are requesting accommodations identical to those approved for you by
ETS within the last two years. If you are requesting accommodations other than those listed in Part II,
you must describe them under “Other Accommodations.”
Accommodations for Health-related Needs
Health-related needs are most commonly those affecting digestion, immune function, respiration, circulation,
endocrine functions, etc., and frequently require only minor accommodations. Documented health needs
include conditions such as diabetes, Crohn’s disease and chronic pain. Minor accommodations include but
are not limited to: extra breaks for medication, snacks, beverages or glucose testing materials which are
necessary during the test session.
5
Praxis/SLS Bulletin Supplement for Test Takers with Disabilities or Health-Related Needs
Documentation for health-related needs should include a letter of support from a medical doctor or
other qualied professional stating the nature of the condition and the rationale for the requested
accommodation(s). Please note, handwritten documentation or a note on a prescription pad is not
acceptable.
Commonly Requested Accommodations
• Extended Test Time (all tests are timed)
25 percent (time and one-quarter) or 50 percent (time and one-half) or 100 percent (double time)
• Extra Breaks —The testing clock stops for breaks and does not affect your testing time. Breaks may
be used for medication, snacks, trips to the restroom, etc. Some disabilities, by their nature, result in
fatigue, the need for rest, and/or restroom breaks while not impacting the actual test taking. In these
cases, extra breaks may be more appropriate than extended test time.
• Accommodations for Computer-delivered Tests
Screen magnication
Selectable background and foreground colors
• Assistance
Human reader (available only at test centers)
Human scribe (available only at test centers)
Assistance for spoken directions (only for applicants who are deaf or hard-of-hearing; available
only at test centers)
»
Oral interpreter
»
Sign language interpreter
Assistance for note taking (only for applicants who are blind, legally blind, or have low vision)
»
Braille slate and stylus
»
Perkins brailler
• Alternate Test Formats
Braille
Large-print test book
Large-print answer sheet
Recorded audio
1
Part III — Certication of Eligibility: Accommodations History
All applicants are encouraged to submit Part III — Certication of Eligibility: Accommodations History
form which serves two distinct purposes:
• To provide verication of an individual’s use of accommodations either in college or in the workplace
• As a shortcut for approval of certain specic accommodations for particular disabilities
1
For recorded audio versions of tests containing graphics, a tactile or large-print gure supplement can be provided.
6
Praxis/SLS Bulletin Supplement for Test Takers with Disabilities or Health-Related Needs
STEP 2: Complete Praxis or SLS Test Authorization Voucher Request Form (if not submitting your
materials online)
If you plan to submit your materials to ETS Disabilities Services by email or mail instead of online
at https://www.ets.org/disabilities/test_takers/, complete the Praxis or SLS Test Authorization Voucher
Request Form on pages 23–28 in this Supplement.
STEP 3: Gather Your Disability Documentation
You must submit disability documentation if any of the following are true:
• You are requesting accommodations greater than 50 percent extended test time (time and one-half)
and/or extra breaks.
• You indicate in Part I of the Testing Accommodations Request Form you have a medical condition, or
you check “Other” under “Nature of your disability.”
• You were rst diagnosed with a disability within the past 12 months.
• You are requesting accommodations different from those ETS approved for you within the last
two years.
• You have not previously used the accommodations being requested.
• You have a sensory disability and your accommodations request does NOT match the specications
which follow below.
• You are unable to submit a valid Part III — Certication of Eligibility: Accommodations History form.
DO NOT send documentation if you are not required to do so. Submitting unrequired documentation
will delay the review process. An Individualized Education Program (IEP) or 504 Plan which provides a
history of disability and accommodations use may be helpful; however, an IEP or 504 Plan alone is not
sufcient information for accommodation decision making. For more information regarding documentation
guidelines, please visit www.ets.org/disabilites.
If you are blind or legally blind, you do NOT need to submit documentation if you are submitting a
Certication of Eligibility: Accommodations History form and are requesting only accommodations from
the list below.
• Screen magnication
• Selectable background and foreground colors
• Braille
• Large print (test book and/or answer sheet)
• Recorded audio
• Human reader
• Human scribe
• Braille slate and stylus for note-taking only
• Perkins brailler for note-taking only
• 50 percent or less extended test time (time and one-half)
• Extra breaks
If you have low vision or some other condition which affects visual functioning, such as an eye coordination
disorder, refer to the “Guidelines for Documentation of Blindness and Low Vision in Adolescents and
Adults” online at https://www.ets.org/disabilities/documentation/ and submit your documentation.
If you are blind or legally blind, a request for 100 percent extended test time (double time) does not require
documentation if you are submitting a Part III — Certication of Eligibility: Accommodations History
form and you are requesting braille, a human reader or recorded audio.
7
Praxis/SLS Bulletin Supplement for Test Takers with Disabilities or Health-Related Needs
If you are deaf or hard-of-hearing, you do NOT need to submit documentation if you are submitting
a Part III — Certication of Eligibility: Accommodations History form and are requesting only
accommodations from the list below.
• 50 percent or less extended test time (time and one-quarter or time and one-half)
• Extra breaks
• Sign language interpreter (for check-in assistance and spoken directions only)
• Oral interpreter (for check-in assistance and spoken directions only)
STEP 4: Submit Your Completed Forms and Documentation to ETS Disability Services
Requests for testing accommodations may be submitted online or via email, mail or courier service. We
strongly encourage using the convenient online registration system. Be sure to include the appropriate
documents with your submission. An incomplete application will cause a delay in processing your request.
Submitting Your Material Online in Your ETS Account
You may submit materials online through your ETS account. Praxis test takers can go to
https://www.ets.org/praxis; and SLS test takers can go to https://www.ets.org/sls. Once signed in, select
“Accommodation Status/New Request” under the “Test Takers with Disabilities or Health-related Needs”
section on the home page and follow the instructions.
Submitting Your Material by Email
Be sure to attach the following items with your email message:
Completed Testing Accommodations Request Form
Completed Praxis or SLS Test Authorization Request Form for Test Takers with Disabilities or
Health-related Needs
Disability documentation (if required)
Requests for accommodations should be sent to disability.reg@ets.org.
Please note: Do not include credit card information with your mail or email. Once your application has
been received at ETS, you will receive an email with instructions regarding payment options.
Submitting Your Material by Mail or Courier Service
Be sure to include the following with your request:
Completed Testing Accommodations Request Form
Completed Praxis or SLS Test Authorization Request Form for Test Takers with Disabilities or
Health-related Needs
Disability documentation (if required)
Mail your material to the appropriate address below.
Mail
E
T
S
Disability Services
PO Box 6054
Princeton, NJ 08541-6054
U.S.A
Courier Service
ETS Disability Services
225 Phillips Boulevard
Ewing, NJ 08628-1426
U.S.A.
8
Praxis/SLS Bulletin Supplement for Test Takers with Disabilities or Health-Related Needs
Once your accommodations have been approved, you will receive an email from ETS Disability Services
with instructions regarding how to register for the Praxis or SLS test.
Regardless of how you submit your material, ETS Disability Services will contact you via email regarding
your application.
CHANGING OR CANCELLING A TEST
If you are scheduled to take a computer-delivered test at a Prometric
®
center, you may change or cancel
your test by calling Prometric at 1-800-967-1139. For all other testing, contact ETS Disability Services.
See page 2 for contact information.
PRAXIS OR SLS TEST PREPARATION
Information about test preparation materials for the Praxis test is available at www.ets.org/praxis/prepare/
materials
. Information about test preparation for the SLS is available at www.ets.org/sls/prepare/materials.
If you need Praxis or SLS test preparation materials in an alternate format not already on the program
website, contact ETS Disability Services. See page 2 for contact information.
SCORE REPORTING
Information about score reporting can be found in the Praxis/SLS Information Bulletin or on the
program’s websites. Praxis score reporting information can be found at http://www.ets.org/praxis/scores;
School Leadership Series score reporting information can be found at https://www.ets.org/sls/scores/reports.
Test takers who are blind can contact ETS Disability Services by phone for their test scores. See page 2 for
contact information.
9
Testing Accommodations Request Form Part I - Applicant Information
PRAXIS/SCHOOL LEADERSHIP SERIES TESTING ACCOMMODATIONS
REQUEST FORM
Part I — Applicant Information
Instructions: Complete this page and sign the Applicant’s Verication Statement on page 15.
Today’s Date: ______
Month
/_ ______
Day
/
Year
_____
Applicant’s Name (print your name as it appears on your ID documents — leave one blank box between names)
First Name M.I. Last Name
Address Line 1
Address Line 2
City State or Province
ZIP or Postal Code Country
Gender
Male Female
Date of Birth
Month
Day
Year
U.S. Social Security Number
(last 4 digits)
Day Phone Number Evening Phone Number
Fax Number Email Address
Test/assessment I am applying for: Praxis
School Leadership Series
Testing Location (Please select one): I intend to test at home I intend to test at a test center
Nature of your disability (check all that apply):
Blind or legally blind
Low vision
Deaf
Hard-of-hearing
ADD/ADHD
Learning Disability
Traumatic Brain Injury
Autism Spectrum
Disorder (e.g., Asperger)
Physical (identify condition)
Psychological (identify condition)
Medical condition (identify condition; must submit documentation)
Other (identify condition; must submit documentation)
When was your disability rst diagnosed? _____
Month
/
Year
_____ Date of professional’s most recent evaluation:
Month
_____/_____
Year
Other than testing accommodations, describe what strategies, devices or medications you ordinarily use to manage your
condition (Optional):
10
11
Acknowledgment
ACKNOWLEDGMENT
This Acknowledgment, including the Privacy Notice at www.ets.org/legal/privacy, contains the terms and
conditions between you and Educational Testing Service (“ETS,” “we,” “us,” “our”) regarding the ETS
test you are now registering for and/or the testing products and services you are now requesting (these
are together referred to as “Testing Services”). It applies to all actions you take regarding the Testing
Services, including creating an online account, providing survey information regarding a test that you take,
requesting one of our services relating to the test and completing a test or product order and providing
payment information.
Personal Information
In registering for the Testing Services, you acknowledge and agree that we have the right to obtain, collect,
store use, disclose (including to public authorities and score recipients), extract and transmit (collectively
“use”) the personal information you provide, including your full name, home address, email address,
telephone number, social security or similar number, passport number, national ID number, gender,
nationality, age, date of birth, responses to other background information questions, test administration
date and details, payment information and how you specically use our Website. This also includes our
use of biometric data (including ngerprints, audio recordings, facial images and video les) provided
by you in the course of your registering for and participating in the Testing Services. All of the above
data is referred to as “Personal Information.” Which Personal Information we hold, how we use it and
how long we hold it for may be subject to legal limitations in the jurisdiction in which you receive the
Testing Services. ETS strives to meet these legal requirements, and further information on how we do so is
provided below.
How We Use Your Personal Information
We use your Personal Information to:
• complete any registration, purchases or other transactions you request
• improve our products and services, and identify, develop and offer new or expanded products and
services
• improve and personalize your experience on the Website, and customize the content and/or format
of the pages you visit
• subject to your opting-in (see below), notify you about updates, products, services and/or special
offers from ETS, its afliates and selected third parties
• ask you to participate in brief surveys or provide other information
• generate aggregate statistical studies and conduct research ourselves or jointly with others related
to our products and services and the use of our Website
If you agree (or have agreed) under other agreements with ETS that we may use your Personal
Information in additional ways, those other agreements will not be limited by this separate
Acknowledgment.
International Transfer
ETS, its Website, and its servers are located in the United States. Therefore, your information, including
Personal Information, will be transferred from your location to the United States in accordance with
applicable laws. It may also be transferred directly from your location or via the U.S. to other countries
who provide processing services to ETS, all at the direction of ETS and in accordance with applicable
laws. In accepting this Acknowledgment, you are agreeing to cross-border transfers of your information,
including your Personal Information. If you do not agree to these cross-border transfers, then you should
refrain from using the Website. You may have a right under applicable law to revoke your consent to the
international transfer of your Personal Information. If you do so, we are unlikely to be able to continue
providing the Testing Services to you.
12
Acknowledgment
Third Party Disclosure
We communicate your Personal Information to certain third parties, within the jurisdiction of your
location and elsewhere, with whom we have a direct or indirect business or contract relationship in order
to provide you with the Testing Services you have requested. These third parties assist with various aspects
of the delivery of the Testing Services, including security services and score distribution services.
Your Rights
In some instances, under applicable laws, you have the right to withdraw your consent and require us to
delete your Personal Information should the lawful purposes for which we hold it cease. You may also
request that we correct your Personal Information if it is incorrect, inaccurate, misleading or incomplete.
To protect your privacy and security, we will take reasonable steps to verify your identity before granting
access or making corrections.
If required under applicable laws, at your request and on satisfactory proof of identity (as determined
by ETS), we will provide you (i) conrmation that we hold your Personal Information, (ii) details or a
description of the Personal Information we hold in an intelligible form; (iii) information of how we came
to hold the Personal Information, the purposes for which we are using it, and in some cases the methods
and logic we use in processing the Personal Information; (iv) further corporate information regarding ETS
and, in some circumstances, the other corporate entities who may process the Personal Information on
behalf of ETS.
To request any of the above actions, please contact us at: Educational Testing Service, 660 Rosedale Road,
Princeton, NJ 08541, USA, email: etsinfo@ets.org.
You may also have the right under certain applicable laws to complain to a regulatory authority in
your country if you believe we have not processed your Personal Information in compliance with
applicable laws.
Further Communications
We ask you to provide your contact details, including email address, telephone and mobile phone details.
We use this information so that we can quickly provide you with information (principally by way of
email, telephone, SMS or other electronic means) regarding the Testing Services you have requested
and to provide you with information about other testing products and services (which we will do in
accordance with applicable laws). When you receive communications from us about other testing
products and services, you will have the opportunity of subsequently opting-out of receiving these, and
our communications will contain instructions on how to do so. Remember, however, that we may still
send emails or call you in order to provide the Testing Service you have purchased or otherwise requested
from us.
Governing Law
You agree that this Acknowledgment will be governed by and construed in accordance with the laws of
the United States and the State of New Jersey, without regard to principles of conict of laws.
Additional Information
This section containing additional information is of general application, but it is also provided for
purposes of the EU General Data Protection Regulation when it comes into force (to the extent the
Regulation is applicable to you in the context of the Testing Services): ETS Corporate Details (including
contact details): Educational Testing Service, 660 Rosedale Road, Princeton, NJ 08541, USA, email:
etsinfo@ets.org.
13
Acknowledgment
Purpose and Legal Basis for Processing: To provide tests and testing services as requested, including
processing for the administration of tests, such as marking and score reporting to test takers and
nominated score recipients.
Legitimate Interests relied upon: ETS requires your Personal Information for purposes of administering
educational tests and providing these tests in a secure manner so that test takers receive accurate results
and test qualications are recognized by intended score recipients.
International Transfers: Data will be transferred to data processors engaged by ETS in various
jurisdictions outside of the EEA, depending on the particular Testing Services requested. These transfers
are made in accordance with the acknowledgment you have given above and intercompany and third party
transfer agreements, in accordance with applicable laws.
Personal Information Retention: Personal Information is generally held for 5 years from the date of its
submission. This period may be extended by ETS if the score for the Testing Service you require remains
valid for a longer period (which information is usually contained in your testing result information), if the
Testing Service you have requested is being reviewed or if our legitimate interest in retaining your Personal
Information remains in place. It also may be shorter if we no longer require your Personal Information
(for example, if you have expressed interest in a test but have not taken one). You may contact us at
etsinfo@ets.org if you require further information.
Data Subject Rights: In addition to the rights described above, you may have data portability rights. For
security reasons, most testing organizations will require that Personal Information be obtained directly
from you and this may limit the usefulness of your data portability rights.
Supervisory Body: Please contact the national data processing authority in the jurisdiction in which you
receive the Testing Services.
For Hong Kong residents only: Subject to applicable laws regarding our use of your Personal Information,
we will not use your Personal Information if we do not reasonably believe that such use is in your
interests. In order for us to supply you with the Testing Services, you must supply us with your Personal
Information to complete any registration, purchase or other transaction you request online and/
or perform any of our other contractual obligations to you which requires us to have the Personal
Information.
For Australian residents only: please be informed that if you agree to the overseas disclosure of the
information or transfer of your data outside of Australia, ETS and its afliates will not be required to
take reasonable steps to ensure that ETS or its afliates’ use of such data outside of Australia does not
breach the Australian Privacy Principles.
For Canadian residents only: This is the notication that ETS is required to provide to Canadian residents.
Please see above regarding International Data Transfers. Where we transfer Personal Data to third
parties we contractually require third parties to have a written procedures in place that comply with the
requirements of the applicable privacy laws in Canada.
For Singapore residents only: In connection with the transfer of your Personal Information outside of
Singapore, ETS believes that the laws of the recipient country of your Personal Information will provide a
standard of protection comparable to the applicable laws of Singapore.
14
Acknowledgment
Contact Information
If you have questions or requests concerning our use of your Personal Information, you should contact:
etsinfo@ets.org.
By indicating “Accept,” you expressly and voluntarily acknowledge and agree to the terms and conditions
above, particularly those relating to our use of biometric data and the international transfer of Personal
Information.
1
1
If you are a minor as determined by applicable law and living outside of the United States, to the extent required by applicable law, the person
clicking “Accept” must be a parent or guardian.
Testing Accommodations Request Form Part I - Applicant Information
   
   
   
   
   
       
   
   
   
_______________________________________________________ ____________________
PRAXIS/SCHOOL LEADERSHIP SERIES TESTING ACCOMMODATIONS
REQUEST FORM
Part I — Applicant Information (continued)
Applicant’s Name:
(Please Print) First Name M.I. Last Name
___________________________________________________________________________
Verication Statement to Be Signed by Applicant
I attest to the fact that the information recorded on this application is true, and if this application is not sufcient, I
agree to provide ETS with any additional information or documentation requested in order to evaluate my request for
accommodations. I also give permission to release to ETS a copy of any pertinent information required to establish the
need for the accommodation(s) requested herein. If I am requesting the use of an assistive device, I am familiar with
its use.
I understand that all information that is necessary to process this application must be available to ETS sufciently
in advance of the test administration date to provide time to evaluate and process my request for accommodations.
I also understand that processing can take approximately four to six weeks from the time the application is complete.
If additional information is requested, it may be approximately another two to four weeks from the time the new
documentation is received until the review is complete. I acknowledge that ETS reserves the right to make nal
determination as to whether any requested accommodation is warranted and appropriate.
If I am submitting Part III — Certication of Eligibility: Accommodations History form, I acknowledge that my request for
accommodations will not be processed if I alter or revise Part III in any way after the appropriate ofcial has completed it.
I also understand that ETS does not waive its right to ask the person who completes Part III on my behalf to submit the
supporting documentation, if necessary, either before or after the test administration date.
I authorize any person completing Part III — Certication of Eligibility: Accommodations History form on my behalf to
release this information to ETS upon ETS’s request. I also understand that the documentation in support of my request for
accommodations supersedes any information contained in the Certication of Eligibility: Accommodations History form.
For quality assurance, the Certication of Eligibility: Accommodations History form may be subject to audit resulting in a
review of the actual disability documentation on le.
I acknowledge that any submitted information may also be used for research purposes, and that in no case will any
individual be identied by name in research studies, and that the information will be protected by the terms of ETS’s
Condentiality of Data Policy.
I further understand that ETS reserves the right to withhold or cancel my scores if it is subsequently determined that,
in ETS’s judgment, any information presented in this application or supporting documentation is either questionable,
inaccurate or used to obtain accommodations that are not necessary.
I understand that ETS has contracted with an external panel of expert consultants with whom it may consult to augment
its in-house expertise. By submitting my request for accommodations, I authorize and provide my consent to ETS to
share my personal information as needed concerning this request.
Signature of Applicant Today’s Date
Keep a copy of this completed form for your records.
15
Testing Accommodations Request Form Part II - Accommodations Requested
_____________________________ ______________
PRAXIS/SCHOOL LEADERSHIP SERIES TESTING ACCOMMODATIONS
REQUEST FORM
Part II — Accommodations Requested
Applicant’s Name:
(Please Print)
___________________________________________________________________________
First Name M.I. Last Name
Today’s Date: ______
Month
/______
Day
/______
Year
If you have received E TS  approval within the last two years for accommodations identical to those you are requesting now,
and your documentation is still current, please indicate the following:
Program: GACE
®
GRE
®
HiSET
®
ParaPro Praxis
®
School Leadership Series TOEFL
®
Previous test(s) taken: _____________________________ Previous test date(s) (month/year): ______________
REQUESTED ACCOMMODATIONS (Check all that apply)
Extended Testing Time (NOTE: All tests are timed; if you are requesting more than 50 percent extended time,
documentation must be submitted.)
25 percent (time and one-quarter) 50 percent (time and one-half) 100 percent (double time)
Extra Breaks. Breaks are not included in testing time (can be used for medication, snacks, trips to the restroom, etc.)
Yes
Accommodations for Computer-delivered Tests
Screen magnication
Selectable background and foreground colors
Alternate Test Formats
Braille (only applicants who are blind or have low vision)
Large-print test book
Large-print answer sheet
Audio recording
1
(continued on next page)
1
For recorded audio versions of tests containing graphics, a tactile or large-print gure supplement can be provided.
16
Testing Accommodations Request Form Part II - Accommodations Requested
PRAXIS/SCHOOL LEADERSHIP SERIES TESTING ACCOMMODATIONS
REQUEST FORM
Part II — Accommodations Requested (continued)
Applicant’s Name:
(Please Print)
___________________________________________________________________________
First Name M.I. Last Name
Assistance (NOTE: If you are requesting a human reader and/or a scribe, and your disability is NOT blindness or legal
blindness, you must submit documentation for review.)
Human reader (available only at test centers)
Human scribe (available only at test centers)
Braille slate and stylus (for note taking only; and only applicants who are blind or have low vision)
Perkins brailler (for note taking only, and for applicants who are blind or have low vision)
Sign language interpreter (for check-in assistance and spoken directions only) (Only applicants who are deaf or
hard-of-hearing; available only at test centers)
Oral interpreter (for check-in assistance and spoken directions only) (Only applicants who are deaf or hard-of-hearing;
available only at test centers)
Other Accommodations. If you are requesting accommodations other than those listed above (e.g., medical supplies/
assistive devices), please describe them below (including make/model information, if applicable) and submit appropriate
documentation.
1.
2.
3.
4.
5.
17
Testing Accommodations Request Form Part III - Certication of Eligibility: Accommodations History
PRAXIS/SCHOOL LEADERSHIP SERIES TESTING ACCOMMODATIONS
REQUEST FORM
Part III — Certication of Eligibility: Accommodations History
Applicant’s Name:
(Please Print)
___________________________________________________________________________
First Name M.I. Last Name
The Certication of Eligibility (COE): Accommodations History form serves two distinct purposes:
• to provide verication of an individual’s use of accommodations in either college or in the workplace
• as a shortcut for approval of certain specic accommodations for most disabilities
A completed COE: Accommodations History will only be considered in place of disability documentation from qualied
applicants with
1. Learning Disability (LD), Attention Decit Hyperactivity Disorder (ADHD), Traumatic Brain Injury (TBI), Autism
Spectrum Disorder (ASD), psychiatric disabilities and/or physical disabilities, who are requesting 50% extended
time or less and/or additional breaks only; OR
2. Blindness/legal blindness or hearing loss who are requesting those accommodations listed on pages 7–8 for
these conditions.
For any other accommodations (double time, scribe, reader, etc.) applicants must submit disability documentation directly
to E TS  for review.
This form must be completed and signed by an authorized professional representing one of the following:
• Ofce of Accessibility/Disability Services at test taker’s college or university
• Human Resources ofce at test taker’s place of employment
• Department of Vocational Rehabilitation (DVR) ofce in test taker’s state of residence
Certication of Eligibility: Accommodations History forms completed and signed by members of the applicant’s
family, or by the individual who diagnosed or is treating the disability, will not be considered.
After reading this page, please complete pages 19 to 22.
18
Testing Accommodations Request Form Part III - Certication of Eligibility: Accommodations History
PRAXIS/SCHOOL LEADERSHIP SERIES TESTING ACCOMMODATIONS
REQUEST FORM
Part III — Certication of Eligibility: Accommodations History (continued)
Applicant’s Name:
(Please Print)
___________________________________________________________________________
First Name M.I. Last Name
DIRECTIONS FOR COMPLETING THE CERTIFICATION OF ELIGIBILITY: ACCOMMODATIONS HISTORY
The COE can be used in lieu of documentation or as verication of the accommodations used in a postsecondary setting.
The authorized professional should initial each of the documentation criteria listed below. Please clearly write your initials
for each item.
Does the candidate’s documentation…
Yes No N/A
1.
Meet the recency criteria set forth at www.ets.org/disabilities (e.g., LD, ADHD,
and/or ASD within 5 years; psychiatric with 1 year, etc.)?
2.
Include complete educational, developmental, and medical history relevant to the
disability for which accommodations are being requested?
3.
Describe the functional limitations resulting from the diagnosed disability?
4.
List the test instruments used in the evaluation report and relevant subtest scores
used to document the stated disability? (All test instruments should have adult
norms.)
5.
Describe the specic accommodation(s) requested and adequately support each
requested accommodation?
6.
Present itself on ofcial letterhead, typed, signed, and dated by an evaluator qualied
to make the diagnosis (include information about license, certication,
and area of specialization)?
19
Testing Accommodations Request Form Part III - Certication of Eligibility: Accommodations History
PRAXIS/SCHOOL LEADERSHIP SERIES TESTING ACCOMMODATIONS
REQUEST FORM
Part III – Certication of Eligibility: Accommodations History (continued)
Applicant’s Name:
(Please Print)
___________________________________________________________________________
First Name M.I. Last Name
Provide the following information regarding the disability documentation on le:
A. Name and credentials of the professional who completed the most recent evaluation.
(e.g., Susan Smith, MD, Psychiatrist)
Name Degree Area of Expertise
B. Date of professionals most recent evaluation: _______
Month
/
Year
_______
C. Applicant’s diagnosed disability or disabilities, as stated in the documentation, for which accommodations have
been granted:
D. Please indicate the accommodations the applicant has received at your institution.
Extended testing time (NOTE: all tests are timed; if applicant is requesting more than 50% extended time
documentation must be submitted). Please check the appropriate box:
25% 50% 100% Other _____
Please list all other approved testing accommodations: If the student used a “reduced distraction testing
environment,” please describe that environment.
1. _______________________________________________________________________________________________
2. _______________________________________________________________________________________________
3. _______________________________________________________________________________________________
4. _______________________________________________________________________________________________
5. _______________________________________________________________________________________________
E. During what period of time has the applicant used the above accommodations?
______ _______ _
From
Month
/
Year
To
Month
_______ _______ /
Year
20
Testing Accommodations Request Form Part III - Certication of Eligibility: Accommodations History
PRAXIS/SCHOOL LEADERSHIP SERIES TESTING ACCOMMODATIONS
REQUEST FORM
Part III — Certication of Eligibility: Accommodations History (continued)
Applicant’s Name:
(Please Print) First Name M.I. Last Name
___________________________________________________________________________
F. Has the applicant used these accommodations for at least one semester or four months?
_____yes _____no
G. Where has the applicant used the accommodations?
College/University
Place of Employment
Other (indicate): ________________________________________
I certify that the accommodations indicated in Part III – Certication of Eligibility: Accommodations History form are those
that were documented as necessary and approved for the applicant.
I certify that I have reviewed the Educational Testing Service (ETS) Documentation Criteria (including ETS guidelines
about LD, ADHD and psychiatric disabilities, if applicable), and that the applicant’s documentation supporting the disability
or disabilities and the need for specic accommodations meets those criteria and is on le in this ofce. For quality
assurance, Part III – Certication of Eligibility: Accommodations History form may be subject to an audit resulting in a
review of the actual disability documentation on le.
In the event that ETS requests a copy of any of the documentation cited above, I agree to send ETS, for its consideration,
the complete le of documentation pertinent to establishing the need for these accommodations. I understand that the
applicant authorizes the release of this information pursuant to the applicant’s verication statement.
I also understand that if ETS determines at any time that the applicant’s documentation does not meet ETS’s
Documentation Criteria, ETS will withhold or cancel the applicant’s score(s).
21
click to sign
signature
click to edit
Testing Accommodations Request Form Part III - Certication of Eligibility: Accommodations History
_________________________________________ _____________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________ _________________________________________
_________________________________________________________________________________________________
PRAXIS/SCHOOL LEADERSHIP SERIES TESTING ACCOMMODATIONS
REQUEST FORM
Part III — Certication of Eligibility: Accommodations History (continued)
Applicant’s Name:
(Please Print)
__________________________________________________________________________________
First Name M.I. Last Name
Authorized Professional’s Verication Statement
To be signed by an authorized person in the Ofce of Accessibility/Disability Services, a Human Resources
counselor at place of employment or a Vocational Rehabilitation counselor. NOTE: The evaluator who
diagnosed or is treating the individual cannot complete this form.
Signature of Authorized Professional Today’s Date
Print Name
Title
Name of Institution/Agency/Place of Employment
Telephone Fax #
Email Address
Attach Business Card Here
22
TEST AUTHORIZATION VOUCHER REQUEST FORM
If paying by paper check or money order, mail this completed form with your test fee to:
ETS–Praxis
PO BOX 382065
Pittsburgh, PA 15251-8065
Check here if you are not requesting testing accommodations.
Check here if you are requesting testing accommodations. Before you fill out this form, you must create a profile at
www.ets.org/praxis/register.
When you create your profile, a candidate ID number will be assigned to you. After you get your candidate ID number, complete this form and follow
the instructions in the Bulletin Supplement for Test Takers with Disabilities or Health-Related Needs at www.ets.org/praxis/register/disabilities.
PLEASE PRINT ALL INFORMATION CALLED FOR BELOW.
NAME: Print your last name, first name, and middle initial.
Last Name – first 15 letters
First Name – first 10 letters
M.I.
MAILING ADDRESS: Number and Street (include apartment number)
City
State ZIP Code (U.S. only)
Country Code
(Outside U.S. & P.R. only)
EMAIL ADDRESS
DATE OF BIRTH
Month Day
Year
SOCIAL SECURITY NUMBER
– –
DAYTIME TELEPHONE NUMBER
–
–
Candidate ID (if known)
TEST CODE
TEST NAME
For test takers requesting an accommodation:
PREFERRED TEST DATE _____________________________ PREFERRED TEST LOCATION _________________________________
PAYMENT
Please make check or money order payable to ETS–Praxis. Do not send cash. Orders received without payment or with incorrect
payment may be returned. If you are requesting an accommodation and prefer to pay online, do not send your payment with this form.
You can pay online after your accommodation has been approved.
NOTE: By sending your check to us, you authorize ETS to convert the check into an electronic fund transfer. Please be aware that your bank account may be
debited as soon as the same day we receive your payment and you will not receive a canceled check. If you do not have sufficient funds in your account,
an additional service fee of $20 will be added to your account.
Payment enclosed
If paying by credit card, indicate which card you are using and provide your card number, expiration date and the cardholder’s signature.
IMPORTANT NOTE: If you are requesting testing accommodations and are emailing your documents, do not include credit card information on this
reg
istration form. Once your application has been received, you will be sent an email with instructions regarding payment.
American Express
®
Discover
®
JCB
®
MasterCard
®
Visa
®
Credit Card Account Number
Expiration Date (MM/YY)
Cardholder’s Signature
I understand and acknowledge the terms and conditions outlined in the Acknowledgment policy on the next page of this form.
Please write, DO NOT PRINT, the following statement.
I hereby agree to the conditions set forth in the 2021–22 Praxis Information Bulletin, specifically those concerning test administration,
payment of fees, the reporting of scores, and the confidentiality of test questions. I certify that I am the person who will take the test at
the center and whose name and address appear on this form.
Signature: Date:
2021-22 Praxis
®
Test Authorization Voucher Request Form
23
2021-22 Praxis
®
Test Authorization Voucher Request Form
TEST AUTHORIZATION VOUCHER REQUEST FORM (continued)
ACKNOWLEDGMENT
This Acknowledgment, including the Privacy Notice at www.ets.org/legal/privacy, contains the terms and conditions between you and
Educational Testing Service (“ETS,” “we,” “us,” “our”) regarding the ETS test you are now registering for and/or the testing products
and services you are now requesting (these are together referred to as “Testing Services”). It applies to all actions you take regarding the
Testing Services, including creating an online account, providing survey information regarding a test that you take, requesting one of our
services relating to the test and completing a test or product order and providing payment information.
Personal Information
In registering for the Testing Services, you acknowledge and agree that we have the right to obtain, collect, store, use, disclose (including
to public authorities and score recipients), extract and transmit (collectively “use”) the personal information you provide, including your
full name, home address, email address, telephone number, social security or similar number, passport number, national ID number,
gender, nationality, age, date of birth, responses to other background information questions, test administration date and details,
payment information and how you specifically use our Website. This also includes our use of biometric data (including fingerprints, audio
recordings, facial images and video files) provided by you in the course of your registering for and participating in the Testing Services.
All of the above data is referred to as “Personal Information.” Which Personal Information we hold, how we use it and how long we hold
it for may be subject to legal limitations in the jurisdiction in which you receive the Testing Services. ETS strives to meet these legal
requirements, and further information on how we do so is provided below.
How We Use Your Personal Information
We use your Personal Information to:
• complete any registration, purchases or other transactions you request
• improve our products and services, and identify, develop and offer new or expanded products and services
• improve and personalize your experience on the Website, and customize the content and/or format of the pages you visit
• subject to your opting-in (see below), notify you about updates, products, services and/or special offers from ETS, its affiliates and
selected third parties
• ask you to participate in brief surveys or provide other information
• generate aggregate statistical studies and conduct research ourselves or jointly with others related to our products and services and
the use of our Website
If you agree (or have agreed) under other agreements with ETS that we may use your Personal Information in additional ways, those
other agreements will not be limited by this separate Acknowledgment.
International Transfer
ETS, its Website, and its servers are located in the United States. Therefore, your information, including Personal Information, will be
transferred from your location to the United States in accordance with applicable laws. It may also be transferred directly from your
location or via the U.S. to other countries who provide processing services to ETS, all at the direction of ETS and in accordance with
applicable laws. In accepting this Acknowledgment, you are agreeing to cross-border transfers of your information, including your
Personal Information. If you do not agree to these cross-border transfers, then you should refrain from using the Website. You may have a
right under applicable law to revoke your consent to the international transfer of your Personal Information. If you do so, we are unlikely
to be able to continue providing the Testing Services to you.
Third-Party Disclosure
We communicate your Personal Information to certain third parties, within the jurisdiction of your location and elsewhere, with whom
we have a direct or indirect business or contract relationship in order to provide you with the Testing Services you have requested. These
third parties assist with various aspects of the delivery of the Testing Services, including security services and score distribution services.
Your Rights
In some instances, under applicable laws, you have the right to withdraw your consent and require us to delete your Personal Information
should the lawful purposes for which we hold it cease. You may also request that we correct your Personal Information if it is incorrect,
inaccurate, misleading or incomplete. To protect your privacy and security, we will take reasonable steps to verify your identity before
granting access or making corrections.
If required under applicable laws, at your request and on satisfactory proof of identity (as determined by ETS), we will provide you (i)
confirmation that we hold your Personal Information, (ii) details or a description of the Personal Information we hold in an intelligible
form; (iii) information of how we came to hold the Personal Information, the purposes for which we are using it, and in some cases
the methods and logic we use in processing the Personal Information; (iv) further corporate information regarding ETS and, in some
circumstances, the other corporate entities who may process the Personal Information on behalf of ETS.
To request any of the above actions, please contact us at: Educational Testing Service, 660 Rosedale Road, Princeton, NJ 08541, USA,
email: etsinfo@ets.org
You may also have the right under certain applicable laws to complain to a regulatory authority in your country if you believe we have
not processed your Personal Information in compliance with applicable laws.
Further Communications
We ask you to provide your contact details, including email address, telephone and mobile phone details. We use this information so
that we can quickly provide you with information (principally by way of email, telephone, SMS or other electronic means) regarding
the Testing Services you have requested and to provide you with information about other testing products and services (which we will
do in accordance with applicable laws). When you receive communications from us about other testing products and services, you will
24
TEST AUTHORIZATION VOUCHER REQUEST FORM (continued)
have the opportunity of subsequently opting-out of receiving these, and our communications will contain instructions on how to do so.
Remember, however, that we may still send emails or call you in order to provide the Testing Service you have purchased or otherwise
requested from us.
Governing Law
You agree that this Acknowledgment will be governed by and construed in accordance with the laws of the United States and the State of
New Jersey, without regard to principles of conflict of laws.
Additional Information
This section containing additional information is of general application, but it is also provided for purposes of the EU General Data
Protection Regulation when it comes into force (to the extent the Regulation is applicable to you in the context of the Testing Services):
ETS Corporate Details (including contact details): Educational Testing Service, 660 Rosedale Road, Princeton, NJ 08541, USA, email:
etsinfo@ets.org
Purpose and Legal Basis for Processing: To provide tests and testing services as requested, including processing for the administration
of tests, such as marking and score reporting to test takers and nominated score recipients.
Legitimate Interests relied upon: ETS requires your Personal Information for purposes of administering educational tests and
providing these tests in a secure manner so that test takers receive accurate results and test qualifications are recognized by intended
score recipients.
International Transfers: Data will be transferred to data processors engaged by ETS in various jurisdictions outside of the EEA,
depending on the particular Testing Services requested. These transfers are made in accordance with the acknowledgment you have given
above and intercompany and third party transfer agreements, in accordance with applicable laws.
Personal Information Retention: Personal Information is generally held for 5 years from the date of its submission. This period may be
extended by ETS if the score for the Testing Service you require remains valid for a longer period (which information is usually contained
in your testing result information), if the Testing Service you have requested is being reviewed or if our legitimate interest in retaining
your Personal Information remains in place. It also may be shorter if we no longer require your Personal Information (for example, if you
have expressed interest in a test but have not taken one). You may contact us at etsinfo@ets.org if you require further information.
Data Subject Rights: In addition to the rights described above, you may have data portability rights. For security reasons, most
testing organizations will require that Personal Information be obtained directly from you and this may limit the usefulness of your data
portability rights.
Supervisory Body: Please contact the national data processing authority in the jurisdiction in which you receive the Testing Services.
For Hong Kong residents only: Subject to applicable laws regarding our use of your Personal Information, we will not use your
Personal Information if we do not reasonably believe that such use is in your interests. In order for us to supply you with the Testing
Services, you must supply us with your Personal Information to complete any registration, purchase or other transaction you request
online and/or perform any of our other contractual obligations to you which requires us to have the Personal Information.
For Australian residents only: please be informed that if you agree to the overseas disclosure of the information or transfer of your
data outside of Australia, ETS and its affiliates will not be required to take reasonable steps to ensure that ETS or its affiliates’ use of such
data outside of Australia does not breach the Australian Privacy Principles.
For Canadian residents only: This is the notification that ETS is required to provide to Canadian residents. Please see above regarding
International Data Transfers. Where we transfer Personal Data to third parties we contractually require third parties to have a written
procedures in place that comply with the requirements of the applicable privacy laws in Canada.
For Singapore residents only: In connection with the transfer of your Personal Information outside of Singapore, ETS believes that
the laws of the recipient country of your Personal Information will provide a standard of protection comparable to the applicable laws of
Singapore.
Contact Information
If you have questions or requests concerning our use of your Personal Information, you should contact: etsinfo@ets.org.
By indicating “Accept,” you expressly and voluntarily acknowledge and agree to the terms and conditions above, particularly those
relating to our use of biometric data and the international transfer of Personal Information.
1
1
If you are a minor as determined by applicable law and living outside of the United States, to the extent required by applicable law, the person clicking
“Accept” must be a parent or guardian.
2021-22 Praxis
®
Test Authorization Voucher Request Form
25
25
2021-22 SLS Test Authorization Voucher Request Form
TEST AUTHORIZATION VOUCHER REQUEST FORM
If paying by paper check or money order, mail this completed form with your test fee to:
E T S — SLS
P.O. Box 382065
Pittsburgh, PA 15251-8065
If you would like to pay for your test registration with a credit/debit card or PayPal, and are not
requesting testing accommodations, you do not need to fill out this form. You may register online.
Check here if you are paying by check or money order and are not requesting testing accommodations.
Check here if you are requesting testing accommodations.
PLEASE PRINT ALL INFORMATION CALLED FOR BELOW.
NAME: Print your last name, first name, and middle initial.
Last Name – first 15 letters
First Name – first 10 letters
M.I.
MAILING ADDRESS: Number and Street (include apartment number)
City
State Zip Code (U.S. only)
Country Code
(Outside U.S. & P. R. only)
EMAIL ADDRESS
DATE OF BIRTH
Month Day
Year
19
SOCIAL SECURITY NUMBER
–
–
DAYTIME TELEPHONE NUMBER
–
–
Candidate ID (if known)
PREFERRED TEST DATE PREFERRED TEST LOCATION
SLS TEST FEES
Please check the appropriate box for the test(s) you are planning to take.
$425 School Leaders Licensure Assessment
$350 School Superintendent Assessment
$120 Connecticut Administrator Test
PAYMENT
Please make check or money order payable to ETS–SLS. Do not send cash. Orders received without payment or with
incorrect payment may be returned. If you are requesting an accommodation and prefer to pay online, do not send your
payment with this form. You can pay online after your accommodation has been approved.
NOTE: By sending your check to us, you authorize ETS to convert the check into an electronic fund transfer.
Please be aware that your bank account may be debited as soon as the same day we receive your payment
and you will not receive a canceled check. If you do not have sufficient funds in your account, an additional
service fee of $20 will be added to your account.
Payment enclosed
If paying by credit card, indicate which card you are using and provide your card number, expiration date and the cardholder’s signature.
IMPORTANT NOTE: If you are requesting testing accommodations and are emailing your documents, do not include credit card information
on this registration form. Once your application has been received, you will be sent an email with instructions regarding payme
nt
American Express
®
Discover
®
JCB
®
MasterCard
®
Visa
®
Credit Card Account Number
Expiration Date (MM/YY)
Cardholder’s Signature
I understand and acknowledge the terms and conditions outlined in the Acknowledgment on the next page of this form.
Please write, DO NOT PRINT, the following statement.
I hereby agree to the conditions set forth in the 2019–20 School Leadership Series Assessment Information Bulletin, specifically those
concerning test administration, payment of fees, the reporting of scores, and the confidentiality of test questions. I certify that I am the
person who will take the test at the center and whose name and address appear on this form.
Signature: Date:
26
2021-22 SLS Test Authorization Voucher Request Form
TEST AUTHORIZATION VOUCHER REQUEST FORM (continued)
ACKNOWLEDGMENT
This Acknowledgment, including the Privacy Notice at www.ets.org/legal/privacy, contains the terms and conditions between you
and Educational Testing Service (“ETS,” “we,” “us,” “our”) regarding the ETS test you are now registering for and/or the testing prod
ucts and services you are now requesting (these are together referred to as “Testing Services”). It applies to all actions you take regard
ing the Testing Services, including creating an online account, providing survey information regarding a test that you take, requesting
one of our services relating to the test and completing a test or product order and providing payment information.
-
-
Personal Information
In registering for the Testing Services, you acknowledge and agree that we have the right to obtain, collect, store use, disclose (includ
ing to public authorities and score recipients), extract and transmit (collectively “use”) the personal information you provide, including
your full name, home address, email address, telephone number, social security or similar number, passport number, national ID num
ber, gender, nationality, age, date of birth, responses to other background information questions, test administration date and details,
payment information and how you specifically use our Website. This also includes our use of biometric data (including fingerprints,
audio recordings, facial images and video files) provided by you in the course of your registering for and participating in the Testing
Services. All of the above data is referred to as “Personal Information.” Which Personal Information we hold, how we use it and how
long we hold it for may be subject to legal limitations in the jurisdiction in which you receive the Testing Services. ETS strives to meet
these legal requirements, and further information on how we do so is provided below.
-
-
How We Use Your Personal Information
We use your Personal Information to:
• complete any registration, purchases or other transactions you request
• improve our products and services, and identify, develop and offer new or expanded products and services
• improve and personalize your experience on the Website, and customize the content and/or format of the pages you visit
• subject to your opting-in (see below), notify you about updates, products, services and/or special offers from ETS, its affiliates and
selected third parties
• ask you to participate in brief surveys or provide other information
• generate aggregate statistical studies and conduct research ourselves or jointly with others related to our products and services and
the use of our Website
If you agree (or have agreed) under other agreements with ETS that we may use your Personal Information in additional ways, those
other agreements will not be limited by this separate Acknowledgment.
International Transfer
ETS, its Website, and its servers are located in the United States. Therefore, your information, including Personal Information, will be
transferred from your location to the United States in accordance with applicable laws. It may also be transferred directly from your
location or via the U.S. to other countries who provide processing services to ETS, all at the direction of ETS and in accordance with
applicable laws. In accepting this Acknowledgment, you are agreeing to cross-border transfers of your information, including your
Personal Information. If you do not agree to these cross-border transfers, then you should refrain from using the Website. You may
have a right under applicable law to revoke your consent to the international transfer of your Personal Information. If you do so, we are
unlikely to be able to continue providing the Testing Services to you.
Third-Party Disclosure
We communicate your Personal Information to certain third parties, within the jurisdiction of your location and elsewhere, with whom
we have a direct or indirect business or contract relationship in order to provide you with the Testing Services you have requested.
These third parties assist with various aspects of the delivery of the Testing Services, including security services and score distribution
services.
Your Rights
In some instances, under applicable laws, you have the right to withdraw your consent and require us to delete your Personal
Information should the lawful purposes for which we hold it cease. You may also request that we correct your Personal Information if
it is incorrect, inaccurate, misleading or incomplete. To protect your privacy and security, we will take reasonable steps to verify your
identity before granting access or making corrections.
If required under applicable laws, at your request and on satisfactory proof of identity (as determined by ETS), we will provide you (i)
confirmation that we hold your Personal Information, (ii) details or a description of the Personal Information we hold in an intelligible
form; (iii) information of how we came to hold the Personal Information, the purposes for which we are using it, and in some cases the
methods and logic we use in processing the Personal Information; (iv) further corporate information regarding ETS and, in some cir
cumstances, the other corporate entities who may process the Personal Information on behalf of ETS.
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To request any of the above actions, please contact us at: Educational Testing Service, 660 Rosedale Road, Princeton, NJ 08541, USA,
email: etsinfo@ets.org
You may also have the right under certain applicable laws to complain to a regulatory authority in your country if you believe we have
not processed your Personal Information in compliance with applicable laws.
27
2021-22 SLS Test Authorization Voucher Request Form
TEST AUTHORIZATION VOUCHER REQUEST FORM (continued)
Further Communications
We ask you to provide your contact details, including email address, telephone and mobile phone details. We use this information so
that we can quickly provide you with information (principally by way of email, telephone, SMS or other electronic means) regarding
the Testing Services you have requested and to provide you with information about other testing products and services (which we will
do in accordance with applicable laws). When you receive communications from us about other testing products and services, you will
have the opportunity of subsequently opting-out of receiving these, and our communications will contain instructions on how to do so.
Remember, however, that we may still send emails or call you in order to provide the Testing Service you have purchased or otherwise
requested from us.
Governing Law
You agree that this Acknowledgment will be governed by and construed in accordance with the laws of the United States and the State
of New Jersey, without regard to principles of conflict of laws.
Additional Information
This section containing additional information is of general application, but it is also provided for purposes of the EU General Data
Protection Regulation when it comes into force (to the extent the Regulation is applicable to you in the context of the Testing Services):
ETS Corporate Details (including contact details): Educational Testing Service, 660 Rosedale Road, Princeton, NJ 08541, USA, email:
etsinfo@ets.org
Purpose and Legal Basis for Processing: To provide tests and testing services as requested, including processing for the administration of
tests, such as marking and score reporting to test takers and nominated score recipients.
Legitimate Interests relied upon: ETS requires your Personal Information for purposes of administering educational tests and providing
these tests in a secure manner so that test takers receive accurate results and test qualifications are recognized by intended score recip
ients.
-
-International Transfers: Data will be transferred to data processors engaged by ETS in various jurisdictions outside of the EEA, depend
ing on the particular Testing Services requested. These transfers are made in accordance with the acknowledgment you have given
above and intercompany and third party transfer agreements, in accordance with applicable laws.
Personal Information Retention: Personal Information is generally held for 5 years from the date of its submission. This period may
be extended by ETS if the score for the Testing Service you require remains valid for a longer period (which information is usually
contained in your testing result information), if the Testing Service you have requested is being reviewed or if our legitimate interest
in retaining your Personal Information remains in place. It also may be shorter if we no longer require your Personal Information (for
example, if you have expressed interest in a test but have not taken one). You may contact us at etsinfo@ets.org if you require further
information.
-
Data Subject Rights: In addition to the rights described above, you may have data portability rights. For security reasons, most testing
organizations will require that Personal Information be obtained directly from you and this may limit the usefulness of your data porta
bility rights.
Supervisory Body: Please contact the national data processing authority in the jurisdiction in which you receive the Testing Services.
For Hong Kong residents only: Subject to applicable laws regarding our use of your Personal Information, we will not use your Personal
Information if we do not reasonably believe that such use is in your interests. In order for us to supply you with the Testing Services,
you must supply us with your Personal Information to complete any registration, purchase or other transaction you request online and/
or perform any of our other contractual obligations to you which requires us to have the Personal Information.
For Australian residents only: please be informed that if you agree to the overseas disclosure of the information or transfer of your data
outside of Australia, ETS and its affiliates will not be required to take reasonable steps to ensure that ETS or its affiliates’ use of such
data outside of Australia does not breach the Australian Privacy Principles.
For Canadian Residents only: This is the notification that ETS is required to provide to Canadian residents. Please see above regarding
International Data Transfers. Where we transfer Personal Data to third parties we contractually require third parties to have a written
procedures in place that comply with the requirements of the applicable privacy laws in Canada.
For Singapore Residents only: In connection with the transfer of your Personal Information outside of Singapore, ETS believes that the
laws of the recipient country of your Personal Information will provide a standard of protection comparable to the applicable laws of
Singapore.
Contact Information
If you have questions or requests concerning our use of your Personal Information, you should contact: etsinfo@ets.org.
By indicating “Accept,” you expressly and voluntarily acknowledge and agree to the terms and conditions above, particularly those relat
ing to our use of biometric data and the international transfer of Personal Information.
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1
1
If you are a minor as determined by applicable law and living outside of the United States, to the extent required by applicable law, the person clicking “Accept” must be a parent or guardian.
28
I.N. 824296
145849-103825 • UNLWEB521
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Form 202122: The Praxis Tests and (ETS)

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Completed 9 May 2022

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