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TheUniversityoftheStateofNewYork THESTATEEDUCATIONDEPARTMENT GEDTestingOffice

ATTACHMENTA

APPLICATIONFORGEDTESTING
Mailorbringthisapplicationtoalocaltestcenter. DonotsendittotheNYSEDGEDTestingOffice.
CandidateInformation
1.SocialSecurityNumber

PLEASEPRINTCLEARLYININK
2.PreparationProgramName(ifapplicable) PreparationProgramCode

3.Name:LastName 4.Address(Street/P.O.Box) 5.City 6.TelephoneNumber (_____)________________


AreaCodeNumber

FirstName

MiddleInitial ApartmentNumber State ZipCode 10. Inwhichlanguagedoyou wishtobetested? Check one

7.DateofBirth

8.Age

9.Gender Male Female

q
MonthDayYear

EnglishFrenchSpanish
q q q CityState

11.NameofLastHighSchoolAttendedAddress

PreviousTestInformation
12.HaveyoupreviouslytakentheGEDtest inNewYorkState? 13.Whatnamedidyouuseatthattest? _______________________________________________________________ LastNameFirstNameMiddleInitial 15.TestCenter&Location 16.Date(s)&Year(s) 17.Form(s)ofTest(s)Taken o YES o NO IfYES,completeitems1317. IfNO,gotoitem18.

14.IdentificationNumberUsed

RequestedTestandLocationDates Selectyourpreferredchoicefortestcenteranddate(s)fortakingtheGEDtest.Makeyourchoicefromthelist oftestcenterslocatedat:www.acces.nysed.gov/ged/nys_map/counties.html Printthenameofthetestcenterand thedate(s)youwishtotestonthelinesbelow.


18.TESTCENTER ____________________________19. TESTDATE FIRSTCHOICE______________SECONDCHOICE_________________

20. Areyouapplyingforaccommodationstotheprocedures If"YES"andthisofficehas alreadyauthorized foradministering theGED testbecauseofadisability? o NO oYESaccommodationsforyou,encloseacopy (Ifno,gotoitem21) oftheapprovalletterwithyourapplication. If "YES and this office has not already authorized accommodations, you must visit the NYS GED Website at: www.acces.nysed.gov/ged/accomodations.html Followthedirectionsforsubmittingarequestfortestingaccommodations.

Att.A(cont'd)

EligibilityInformation
21.Areyou19yearsofageorolder? If"YES,"gotoitem23. o o YES NO If NO, go to item 22. You must obtain the appropriate documentation and include the appropriate attachment with this applicationidentifyingtheeligibilitycriteriayoumeet.(B2B 9,C2,C3)

Eligibilityforpersonsundertheageof19only. Youmustbedischargedfromhighschool.Youmustalsohavereached"maximumcompulsoryschool attendanceage(Theschoolyear[July1June30]inwhichyouturned16hasended.


22. Pleaseuseacheckmark(4)toindicateONEeligibilitycategoryyoumeetandattach documentation.

B2

Oneyearhaspassedsinceyouwerelastlegallyabletoleavehighschoolandenrolledinafull timehighschoolprogramofinstruction or B3 Youwereamemberofahighschoolclassthathasalreadygraduated or B4/C2YouareenrolledinanApprovedAlternativeHighSchoolEquivalencyPreparation Program or B5/C3YouhavebeenacceptedintotheU.S.ArmedForces,oryouhavebeenacceptedintoacollege, universityoraccreditedpostsecondaryinstitutionor B6 YouhavebeenamemberoftheJobCorpsforaperiodofatleastsix(6)months or B7 Youareincarcerated/institutionalized or B8 Youareanadjudicatedyouthunderthedirectionofaprison,jail,detentioncenter,paroleor probationofficer. B9 Youareatleast17andhavebeenhomeschooled.

*Underthiseligibilitysuccessful candidateswillonlyreceiveapassingtranscript,notadiploma.

23.IunderstandthatmyeligibilityforGEDtestingwillbedeterminedbasedontheinformationprovidedonthisapplicationand onanyencloseddocumentation.Ifanyofthisinformationisincorrectand,basedonmypriortestingrecord,itis subsequentlydeterminedthatIdidnotmeettheeligibilityrequirementsonthedatethatthetestsessionbegan,Iunderstand that mytestwillnotbescored. Idoherebycertify,subjecttothepenaltyforperjury,thattheinformationgivenonthisform andonanyenclosuresistruetothebestofmyknowledgeandbelief.

CANDIDATESIGNATURE_______________________________________DATE________________ PermissionofParent/Guardian(ifcandidateisunder18)
24. BysigningbelowIamverifyingthattheinformationonthisapplicationistrue.Inaddition,Igivepermissionformy son/daughter(circleone)named____________________________________,totaketheGEDtest.

PARENTSIGNATURE___________________________________________DATE_______________

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