Updated December 2013
Revised June 2009
Date:________________ Instructor:____________________________________ Site:______________
Name of Student: _______
_______________________________________________
D.O.B.__________________
S.S. #:________________
Address:_______________________________________
Phone:_____________
_______________________________________________
Age Waiver: Date submitted:_______________________________ Approved:__________
Not applicable
Accomodations: Requested for:_________________________________ Type:___________________
Not applicable Approval received:
Yes
No
HSE Official Practice Test:
Score Form Used Date of Test Score Form Used Date
Language Arts: Reading
Language Arts: Writing
Science
Math
Social Studies
Average Score
Signed by:____________________________________________________________
______________________
Signature of ABE Instructor Date
Name of Examinee: _____________________________________
Official Test Scores
Standard Scores Percentile Rank Date of Test
Test #1: Language Arts Writing
______________ _____________
Test #2: Language Arts Reading
______________ _____________
Test #3: Mathematics
______________ _____________
Test #4: Science
______________ _____________
Test #5: Social Studies
______________ _____________
Passed
Failed
Average Score: ________________
By signing below, I hereby give the HSE examiner at _________________________ my permission to share
these test scores and score report with the ABE instructor and/or program at Eastern Wyoming College.
_______________________________________________
______________________
Student Signature Date
___________________________________________________ _____________________
Signature (GED examiner) Date
Scores Reported to:___________________________________
(ABE instructor's name)
RETEST Information
HISE Testing Center
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