Rev June 2018
WINTHROP UNIVERSITY
Richard W. Riley College of Education
PRAXIS Voucher Request Form
_____________________________________________________ _________________________________
Student Name (Last, First, Middle) Student ID #
_____________________________________________________ ________________________________
Winthrop Email Phone
Please provide the following information for the PRAXIS test(s) for which you are requesting a voucher.
For test codes and registration fees please visit https://www.ets.org/praxis/register.
Deadlines for submitting voucher request forms can be found at https://www.winthrop.edu/coe/sas/default.aspx?id=6580.
Test Name Test Code Registration Fee
By signing below I acknowledge that I understand that the appropriate fee for the PRAXIS test(s) listed above will be
charged to my Winthrop student account upon placement of the order.
_____________________________________________________ _________________________________
Student Signature Date
OFFICE USE ONLY
Date Received
Date Verified
Date Memo Sent to Student Financial Services
Amount Charged to Student Account
Processed By