Homepage ↝ Blank Connecticut Ed 192 Form
Outline

The Connecticut Ed 192 form is a crucial document for individuals aspiring to become educators in the state. This application serves as a request for a waiver of the Connecticut Academic Skills Assessment, which is a requirement for those seeking admission to educator preparation programs or certification in Connecticut. To successfully complete the form, applicants must provide personal information, including their name, social security number, and educational background. The form also requires official score reports from standardized tests such as the SAT, ACT, GRE, or PAA, which can be used to demonstrate that the applicant has met the necessary academic skills standards. It is important to note that the application will not be processed until all required documentation is received by the Bureau of Educator Standards and Certification. Additionally, applicants must ensure that they follow the specific instructions outlined in the form, as incomplete submissions can lead to delays in the waiver process. Understanding the significance of this form and the requirements associated with it is essential for anyone looking to navigate the certification landscape in Connecticut effectively.

Sample - Connecticut Ed 192 Form

ED 192
REV. 12/11
C.G.S. 10-145f
APPLICATION FOR CONNECTICUT ACADEMIC SKILLS ASSESSMENT WAIVER
The Connecticut Academic Skills Assessment Waiver Application will not be processed until this completed application
ξ™„ξ™‘ξ™‡ξ˜ƒξ™„ξ™‘ξ˜ƒξ˜²ξ˜©ξ˜©ξ˜¬ξ˜¦ξ˜¬ξ˜€ξ˜―ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™•ξ™ˆξ™“ξ™’ξ™•ξ™—ξ˜ƒξ™„ξ™•ξ™ˆξ˜ƒξ™•ξ™ˆξ™†ξ™ˆξ™Œξ™™ξ™ˆξ™‡ξ˜ƒξ™…ξ™œξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜₯ξ™˜ξ™•ξ™ˆξ™„ξ™˜ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¨ξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™’ξ™•ξ˜ƒξ˜Άξ™—ξ™„ξ™‘ξ™‡ξ™„ξ™•ξ™‡ξ™–ξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ˜¦ξ™ˆξ™•ξ™—ξ™ŒξšΏξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜‘ξ˜ƒξ˜ƒξ˜‹ξ˜Άξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ƒξ™–ξ™ˆξ™‘ξ™—ξ˜ƒξ™…ξ™œξ˜ƒξ™šξ™„ξ™Œξ™™ξ™ˆξ™•ξ˜ƒ
ξ™†ξ™„ξ™‘ξ™‡ξ™Œξ™‡ξ™„ξ™—ξ™ˆξ™–ξ˜ƒξ™šξ™Œξ™ξ™ξ˜ƒξ˜±ξ˜²ξ˜·ξ˜ƒξ™…ξ™ˆξ˜ƒξ™„ξ™†ξ™†ξ™ˆξ™“ξ™—ξ™ˆξ™‡ξ˜‘ξ˜Œξ˜ƒξ˜ƒξ˜Άξ™ˆξ™ˆξ˜ƒξ˜³ξ™„ξ™Šξ™ˆξ˜ƒξ˜™ξ˜ƒξ™‰ξ™’ξ™•ξ˜ƒξ™„ξ™“ξ™“ξ™ξ™Œξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ™‡ξ™Œξ™•ξ™ˆξ™†ξ™—ξ™Œξ™’ξ™‘ξ™–ξ˜‘
CONNECTICUT STATE DEPARTMENT OF EDUCATION
ξ˜₯ξ™˜ξ™•ξ™ˆξ™„ξ™˜ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¨ξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™’ξ™•ξ˜ƒξ˜Άξ™—ξ™„ξ™‘ξ™‡ξ™„ξ™•ξ™‡ξ™–ξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ˜¦ξ™ˆξ™•ξ™—ξ™ŒξšΏξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘
P.O. Box 150471 – Room 243
Hartford, CT 06115-0471
www.ct.gov/sde
PAGE 1
LAST NAME
PERSONAL INFORMATION (Print all information in blue ink and in uppercase letters.)
FIRST NAME MI
ξ˜ƒξ˜Άξ˜²ξ˜¦ξ˜¬ξ˜€ξ˜―ξ˜ƒξ˜Άξ˜¨ξ˜¦ξ˜Έξ˜΅ξ˜¬ξ˜·ξ˜Όξ˜ƒξ˜±ξ˜Έξ˜°ξ˜₯ξ˜¨ξ˜΅ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜₯ξ˜¬ξ˜΅ξ˜·ξ˜«ξ˜ƒξ˜§ξ˜€ξ˜·ξ˜¨ξ˜ƒξ˜‹ξ˜°ξ™’ξ™‘ξ™—ξ™‹ξ˜ξ˜§ξ™„ξ™œξ˜ξ˜Όξ™ˆξ™„ξ™•ξ˜Œξ˜ƒξš±ξ˜ƒRequired
ξ˜€ξ˜§ξ˜§ξ˜΅ξ˜¨ξ˜Άξ˜Άξ˜ƒξ˜‹ξ˜Άξ™—ξ™•ξ™ˆξ™ˆξ™—ξ˜Œξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜‹ξ˜€ξ™“ξ™—ξ˜ƒξ˜†ξ˜Œ
ξ˜‹ξ˜¦ξ™Œξ™—ξ™œξ˜Œξ˜ƒξ˜ƒξ˜ƒ
ξ˜‹ξ˜Άξ™—ξ™„ξ™—ξ™ˆξ˜Œξ˜ƒξ˜ƒ ξ˜‹ξ˜½ξ™Œξ™“ξ˜ƒξ˜¦ξ™’ξ™‡ξ™ˆξ˜Œ
ξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜©ξ˜²ξ˜΅ξ˜°ξ˜¨ξ˜΅ξ˜ƒξ˜―ξ˜€ξ˜Άξ˜·ξ˜ƒξ˜±ξ˜€ξ˜°ξ˜¨ξ˜‹ξ˜Άξ˜Œ
ξ˜₯ξ™„ξ™†ξ™‹ξ™ˆξ™ξ™’ξ™•ξšΆξ™–ξ˜ƒξ˜¬ξ™‘ξ™–ξ™—ξ™Œξ™—ξ™˜ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ˜€ξ™—ξ™—ξ™ˆξ™‘ξ™‡ξ™Œξ™‘ξ™Šξ˜’ξ˜€ξ™—ξ™—ξ™ˆξ™‘ξ™‡ξ™ˆξ™‡ξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒ
ξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜³ξ˜«ξ˜²ξ˜±ξ˜¨
ξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜‹ξ˜«ξ™’ξ™ξ™ˆξ˜Œ
ξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜ƒξ˜‹ξ˜Ίξ™’ξ™•ξ™Žξ˜Œ
ξ˜΅ξ™„ξ™†ξ™ˆξ˜’ξ˜¨ξ™—ξ™‹ξ™‘ξ™Œξ™†ξ™Œξ™—ξ™œξ˜ƒ ξ˜”ξ˜‘ξ˜ƒ ξ˜±ξ™„ξ™—ξ™Œξ™™ξ™ˆξ˜ƒξ˜€ξ™ξ™ˆξ™•ξ™Œξ™†ξ™„ξ™‘ξ˜ƒ
ξ˜ƒ ξ˜ƒ ξ˜•ξ˜‘ξ˜ƒ ξ˜€ξ™–ξ™Œξ™„ξ™‘ξ˜’ξ˜³ξ™„ξ™†ξ™ŒξšΏξ™†ξ˜ƒξ˜¬ξ™–ξ™ξ™„ξ™‘ξ™‡ξ™ˆξ™•
ξ˜ƒ ξ˜ƒ ξ˜–ξ˜‘ξ˜ƒ ξ˜₯ξ™ξ™„ξ™†ξ™Žξ˜ƒ
(Optional) ξ˜—ξ˜‘ξ˜ƒ ξ˜Ίξ™‹ξ™Œξ™—ξ™ˆξ˜ƒ
ξ˜ƒ ξ˜ƒ ξ˜˜ξ˜‘ξ˜ƒ ξ˜«ξ™Œξ™–ξ™“ξ™„ξ™‘ξ™Œξ™†
ξ˜ƒξ˜ƒξ˜ƒξ˜ͺξ˜¨ξ˜±ξ˜§ξ˜¨ξ˜΅ξ˜ƒξ˜‹ξ˜°ξ˜’ξ˜©ξ˜Œ
 

 
 
ξ˜ƒ ξ˜¨ξ˜ξ˜°ξ˜€ξ˜¬ξ˜―ξ˜ƒξ˜€ξ˜§ξ˜§ξ˜΅ξ˜¨ξ˜Άξ˜Ά
Essential Skills Testing Requirement Waived Based Upon (Check one):
SAT
ξ˜΅ξ™ˆξ™‰ξ™ˆξ™•ξ˜ƒξ™—ξ™’ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜·ξ™ˆξ™–ξ™—ξ™Œξ™‘ξ™Šξ˜ƒξ˜€ξ™Šξ™ˆξ™‘ξ™†ξ™œξ˜ƒξ˜¦ξ™’ξ™‘ξ™—ξ™„ξ™†ξ™—ξ˜ƒξ˜―ξ™Œξ™–ξ™—ξ˜ƒξ˜‹ξ˜³ξ™„ξ™Šξ™ˆξ˜ƒξ˜–ξ˜Œξ˜ƒξ™‰ξ™’ξ™•ξ˜ƒξ™‡ξ™Œξ™•ξ™ˆξ™†ξ™—ξ™Œξ™’ξ™‘ξ™–ξ˜ƒξ™—ξ™’ξ˜ƒξ™‹ξ™„ξ™™ξ™ˆξ˜ƒξ™„ξ™‘ξ˜ƒξ™’ξ™‰ξšΏξ™†ξ™Œξ™„ξ™ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™•ξ™ˆξ™“ξ™’ξ™•ξ™—ξ˜ƒξ™–ξ™ˆξ™‘ξ™—ξ˜ƒξ™—ξ™’ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜¦ξ™’ξ™‘ξ˜
ξ™‘ξ™ˆξ™†ξ™—ξ™Œξ™†ξ™˜ξ™—ξ˜ƒξ˜Άξ™—ξ™„ξ™—ξ™ˆξ˜ƒξ˜§ξ™ˆξ™“ξ™„ξ™•ξ™—ξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¨ξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜‘
PAAξ˜ƒ ξ˜¦ξ™’ξ™ξ™“ξ™ξ™ˆξ™—ξ™ˆξ˜ƒξ˜³ξ™„ξ™Šξ™ˆξ˜ƒξ˜—ξ˜ƒξ™Œξ™‘ξ˜ƒξ™’ξ™•ξ™‡ξ™ˆξ™•ξ˜ƒξ™—ξ™’ξ˜ƒξ™‹ξ™„ξ™™ξ™ˆξ˜ƒξ™„ξ™‘ξ˜ƒξ™’ξ™‰ξšΏξ™†ξ™Œξ™„ξ™ξ˜ƒξ˜³ξ˜€ξ˜€ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™•ξ™ˆξ™“ξ™’ξ™•ξ™—ξ˜ƒξ™–ξ™ˆξ™‘ξ™—ξ˜ƒξ™—ξ™’ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜¦ξ™’ξ™‘ξ™‘ξ™ˆξ™†ξ™—ξ™Œξ™†ξ™˜ξ™—ξ˜ƒξ˜Άξ™—ξ™„ξ™—ξ™ˆξ˜ƒξ˜ƒ
ξ˜ƒ ξ˜ƒ ξ˜§ξ™ˆξ™“ξ™„ξ™•ξ™—ξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¨ξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜‘
ACT GRE
APPLICATION FOR CONNECTICUT ACADEMIC SKILLS ASSESSMENT WAIVER
The Connecticut Academic Skills Assessment Waiver Application will NOT be processed until this com
ξ™“ξ™ξ™ˆξ™—ξ™ˆξ™‡ξ˜ƒξ™„ξ™“ξ™“ξ™ξ™Œξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ˜Άξ˜€ξ˜·ξ˜’ξ˜€ξ˜¦ξ˜·ξ˜’ξ˜ͺξ˜΅ξ˜¨ξ˜’ξ˜³ξ˜€ξ˜€ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ƒξ™„ξ™•ξ™ˆξ˜ƒξ™•ξ™ˆξ™†ξ™ˆξ™Œξ™™ξ™ˆξ™‡ξ˜ƒξ™…ξ™œξ˜ƒξ™—ξ™‹ξ™Œξ™–ξ˜ƒξ™’ξ™‰ξšΏξ™†ξ™ˆξ˜‘
ξ˜€ξ˜ƒξ™šξ™„ξ™Œξ™™ξ™ˆξ™•ξ˜ƒξ™Œξ™–ξ˜ƒξ™„ξ™‘ξ˜ƒξ™„ξ™ξ™—ξ™ˆξ™•ξ™‘ξ™„ξ™—ξ™Œξ™™ξ™ˆξ˜ƒξ™—ξ™’ξ˜ƒξ™—ξ™„ξ™Žξ™Œξ™‘ξ™Šξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ™“ξ™„ξ™–ξ™–ξ™Œξ™‘ξ™Šξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™„ξ™†ξ™„ξ™‡ξ™ˆξ™ξ™Œξ™†ξ˜ƒξ™–ξ™Žξ™Œξ™ξ™ξ™–ξ˜ƒξ™—ξ™ˆξ™–ξ™—ξ™–ξ˜ƒξ˜‹ξ˜³ξ™•ξ™„ξ™›ξ™Œξ™–ξ˜ƒξ˜¬ξ˜ƒξš±ξ˜ƒξ˜³ξ˜³ξ˜Άξ˜·ξ˜Œξ˜ƒξ™•ξ™ˆξ™”ξ™˜ξ™Œξ™•ξ™ˆξ™‡ξ˜ƒξ™…ξ™œξ˜ƒ
ξ™—ξ™‹ξ™ˆξ˜ƒξ˜Άξ™—ξ™„ξ™—ξ™ˆξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¦ξ™’ξ™‘ξ™‘ξ™ˆξ™†ξ™—ξ™Œξ™†ξ™˜ξ™—ξ˜ƒξ™‰ξ™’ξ™•ξ˜ƒξ™“ξ™•ξ™’ξ™–ξ™“ξ™ˆξ™†ξ™—ξ™Œξ™™ξ™ˆξ˜ƒξ™ˆξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™’ξ™•ξ™–ξ˜‘ξ˜ƒξ˜·ξ™‹ξ™Œξ™–ξ˜ƒξ™Œξ™‘ξ™‰ξ™’ξ™•ξ™ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ™Œξ™–ξ˜ƒξ™“ξ™•ξ™’ξ™™ξ™Œξ™‡ξ™ˆξ™‡ξ˜ƒξ™—ξ™’ξ˜ƒξ™—ξ™‹ξ™’ξ™–ξ™ˆξ˜ƒξ™šξ™‹ξ™’ξ˜ƒξ™„ξ™•ξ™ˆξ˜ƒξ™Œξ™‘ξ™—ξ™ˆξ™•ξ˜
ξ™ˆξ™–ξ™—ξ™ˆξ™‡ξ˜ƒξ™Œξ™‘ξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ™ξ™ˆξ™ˆξ™—ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™†ξ™•ξ™Œξ™—ξ™ˆξ™•ξ™Œξ™„ξ˜ƒξ™—ξ™’ξ˜ƒξ™šξ™„ξ™Œξ™™ξ™ˆξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™„ξ™†ξ™„ξ™‡ξ™ˆξ™ξ™Œξ™†ξ˜ƒξ™–ξ™Žξ™Œξ™ξ™ξ™–ξ˜ƒξ™—ξ™ˆξ™–ξ™—ξ˜ƒξ™•ξ™ˆξ™”ξ™˜ξ™Œξ™•ξ™ˆξ™ξ™ˆξ™‘ξ™—ξ˜‘
Who Must Meet The Academic Skills Requirement?
ξ˜¬ξ™‘ξ™‡ξ™Œξ™™ξ™Œξ™‡ξ™˜ξ™„ξ™ξ™–ξ˜ƒξ™–ξ™ˆξ™ˆξ™Žξ™Œξ™‘ξ™Šξ˜ƒξ™‰ξ™’ξ™•ξ™ξ™„ξ™ξ˜ƒξ™„ξ™‡ξ™ξ™Œξ™–ξ™–ξ™Œξ™’ξ™‘ξ˜ƒξ™—ξ™’ξ˜ƒξ™„ξ˜ƒξ˜¦ξ™’ξ™‘ξ™‘ξ™ˆξ™†ξ™—ξ™Œξ™†ξ™˜ξ™—ξ˜ƒξ™†ξ™’ξ™ξ™ξ™ˆξ™Šξ™ˆξ˜ƒξ™’ξ™•ξ˜ƒξ™˜ξ™‘ξ™Œξ™™ξ™ˆξ™•ξ™–ξ™Œξ™—ξ™œξ˜ƒξ™ˆξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™’ξ™•ξ˜ƒξ™“ξ™•ξ™ˆξ™“ξ™„ξ™•ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ™“ξ™•ξ™’ξ˜
ξ™Šξ™•ξ™„ξ™ξ˜ξ˜ƒξ™’ξ™•ξ˜ƒξ™–ξ™ˆξ™ˆξ™Žξ™Œξ™‘ξ™Šξ˜ƒξ™†ξ™ˆξ™•ξ™—ξ™ŒξšΏξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ™Œξ™‘ξ˜ƒξ˜¦ξ™’ξ™‘ξ™‘ξ™ˆξ™†ξ™—ξ™Œξ™†ξ™˜ξ™—ξ˜ξ˜ƒξ™ξ™˜ξ™–ξ™—ξ˜ƒξ™‰ξ™˜ξ™ξšΏξ™ξ™ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™„ξ™†ξ™„ξ™‡ξ™ˆξ™ξ™Œξ™†ξ˜ƒξ™–ξ™Žξ™Œξ™ξ™ξ™–ξ˜ƒξ™•ξ™ˆξ™”ξ™˜ξ™Œξ™•ξ™ˆξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ™…ξ™œξ˜ƒξ™—ξ™„ξ™Žξ™Œξ™‘ξ™Šξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒ
ξ™“ξ™„ξ™–ξ™–ξ™Œξ™‘ξ™Šξ˜ƒξ™„ξ™ξ™ξ˜ƒξ™—ξ™‹ξ™•ξ™ˆξ™ˆξ˜ƒξ˜³ξ™•ξ™„ξ™›ξ™Œξ™–ξ˜ƒξ˜¬ξ˜ƒξ™—ξ™ˆξ™–ξ™—ξ™–ξ˜ξ˜ƒξ™•ξ™ˆξ™„ξ™‡ξ™Œξ™‘ξ™Šξ˜ξ˜ƒξ™šξ™•ξ™Œξ™—ξ™Œξ™‘ξ™Šξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ™ξ™„ξ™—ξ™‹ξ™ˆξ™ξ™„ξ™—ξ™Œξ™†ξ™–ξ˜žξ˜ƒξ™’ξ™•ξ˜ƒξ™…ξ™œξ˜ƒξ™‰ξ™˜ξ™ξšΏξ™ξ™ξ™Œξ™‘ξ™Šξ˜ƒξ™’ξ™‘ξ™ˆξ˜ƒξ™’ξ™‰ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™šξ™„ξ™Œξ™™ξ™ˆξ™•ξ˜ƒξ™’ξ™“ξ˜
ξ™—ξ™Œξ™’ξ™‘ξ™–ξ˜ƒξ™ξ™Œξ™–ξ™—ξ™ˆξ™‡ξ˜ƒξ™…ξ™ˆξ™ξ™’ξ™šξ˜‘
ξ˜€ξ˜ƒξ™šξ™„ξ™Œξ™™ξ™ˆξ™•ξ˜ƒξ™ξ™„ξ™œξ˜ƒξ™…ξ™ˆξ˜ƒξ™Šξ™•ξ™„ξ™‘ξ™—ξ™ˆξ™‡ξ˜ƒξ™…ξ™œξ˜ƒξ™‰ξ™˜ξ™•ξ™‘ξ™Œξ™–ξ™‹ξ™Œξ™‘ξ™Šξ˜ƒξ™’ξ™‰ξšΏξ™†ξ™Œξ™„ξ™ξ˜ξ˜ƒξ™“ξ™•ξ™’ξ™’ξ™‰ξ˜ƒξ™’ξ™‰ξ˜ƒξ™‹ξ™„ξ™™ξ™Œξ™‘ξ™Šξ˜ƒξ™ξ™ˆξ™—ξ˜ƒξ™’ξ™‘ξ™ˆξ˜ƒξ™’ξ™‰ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™‰ξ™’ξ™ξ™ξ™’ξ™šξ™Œξ™‘ξ™Šξ˜
PAGE 2
Minimum Standards For An Academic Skills Assessment Waiver
Combined
Verbal/Math
Score
ξ˜”ξ˜“ξ˜“ξ˜“
ξ˜”ξ˜”ξ˜“ξ˜“
ξ˜”ξ˜“ξ˜“ξ˜“
ξ˜”ξ˜“ξ˜“ξ˜“
ξ˜¨ξ™”ξ™˜ξ™Œξ™™ξ™„ξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ™—ξ™’ξ˜ƒξ˜”ξ˜“ξ˜“ξ˜“
ξ˜‹ξ™•ξ™ˆξ™‰ξ™ˆξ™•ξ˜ƒξ™—ξ™’
ξ™†ξ™’ξ™‘ξ™™ξ™ˆξ™•ξ™–ξ™Œξ™’ξ™‘ξ˜ƒξ™—ξ™„ξ™…ξ™ξ™ˆξ˜Œ
Test
Name
SAT**
ACT**
GRE**
PAA
Date Test Taken
ξ˜³ξ™•ξ™Œξ™’ξ™•ξ˜ƒξ™—ξ™’ξ˜ƒξ˜°ξ™„ξ™•ξ™†ξ™‹ξ˜ƒξ˜–ξ˜”ξ˜ξ˜ƒξ˜”ξ˜œξ˜œξ˜˜
ξ˜²ξ™‘ξ˜’ξ˜€ξ™‰ξ™—ξ™ˆξ™•ξ˜ƒξ˜€ξ™“ξ™•ξ™Œξ™ξ˜ƒξ˜”ξ˜ξ˜ƒξ˜”ξ˜œξ˜œξ˜˜
ξ˜³ξ™•ξ™Œξ™’ξ™•ξ˜ƒξ™—ξ™’ξ˜ƒξ˜²ξ™†ξ™—ξ™’ξ™…ξ™ˆξ™•ξ˜ƒξ˜”ξ˜œξ˜›ξ˜œ
ξ˜²ξ™‘ξ˜’ξ˜€ξ™‰ξ™—ξ™ˆξ™•ξ˜ƒξ˜²ξ™†ξ™—ξ™’ξ™…ξ™ˆξ™•ξ˜ƒξ˜”ξ˜œξ˜›ξ˜œ
ξ˜³ξ™•ξ™Œξ™’ξ™•ξ˜ƒξ™—ξ™’ξ˜ƒξ˜²ξ™†ξ™—ξ™’ξ™…ξ™ˆξ™•ξ˜ƒξ˜”ξ˜ξ˜ƒξ˜•ξ˜“ξ˜“ξ˜•
ξ˜²ξ™‘ξ˜’ξ˜€ξ™‰ξ™—ξ™ˆξ™•ξ˜ƒξ˜²ξ™†ξ™—ξ™’ξ™…ξ™ˆξ™•ξ˜ƒξ˜”ξ˜ξ˜ƒξ˜•ξ˜“ξ˜“ξ˜•
Verbal/English
Critical Reading
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ξ˜±ξ™’ξ˜ƒξ™ξ™ˆξ™–ξ™–ξ˜ƒξ™—ξ™‹ξ™„ξ™‘ξ˜ƒξ˜—ξ˜“ξ˜“
ξ˜•ξ˜“
22
ξ˜—ξ˜˜ξ˜“
ξ˜—ξ˜˜ξ˜“
ξ˜±ξ™’ξ˜ƒξ™ξ™ˆξ™–ξ™–ξ˜ƒξ™—ξ™‹ξ™„ξ™‘ξ˜ƒξ˜—ξ˜“ξ˜“
Math /
Quantitative
Score
ξ˜±ξ™’ξ˜ƒξ™ξ™ˆξ™–ξ™–ξ˜ƒξ™—ξ™‹ξ™„ξ™‘ξ˜ƒξ˜—ξ˜“ξ˜“
ξ˜”ξ˜š
ξ˜”ξ˜œ
ξ˜˜ξ˜“ξ˜“
ξ˜˜ξ˜“ξ˜“
ξ˜±ξ™’ξ˜ƒξ™ξ™ˆξ™–ξ™–ξ˜ƒξ™—ξ™‹ξ™„ξ™‘ξ˜ƒξ˜—ξ˜“ξ˜“
Analytic
Writing
Score
ξ˜—ξ˜‘ξ˜˜
ESLAT /
TOEFL
Score
ξ˜˜ξ˜”ξ˜“
ξ˜ξ˜ƒ ξ˜²ξ™‰ξšΏξ™†ξ™Œξ™„ξ™ξ˜ƒξ˜Άξ˜€ξ˜·ξ˜ξ˜ƒξ˜€ξ˜¦ξ˜·ξ˜ξ˜ƒξ˜ͺξ˜΅ξ˜¨ξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ˜³ξ˜€ξ˜€ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ƒξ™„ξ™•ξ™ˆξ˜ƒξ™—ξ™‹ξ™’ξ™–ξ™ˆξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ƒξ™–ξ™ˆξ™‘ξ™—ξ˜ƒξ™‡ξ™Œξ™•ξ™ˆξ™†ξ™—ξ™ξ™œξ˜ƒξ™‰ξ™•ξ™’ξ™ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™•ξ™ˆξ™–ξ™“ξ™ˆξ™†ξ™—ξ™Œξ™™ξ™ˆξ˜ƒξ™—ξ™ˆξ™–ξ™—ξ™Œξ™‘ξ™Šξ˜ƒ
ξ™†ξ™’ξ™ξ™“ξ™„ξ™‘ξ™œξ˜‘ξ˜ƒξ˜·ξ™ˆξ™–ξ™—ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™•ξ™ˆξ™“ξ™’ξ™•ξ™—ξ™–ξ˜ƒξ™‰ξ™’ξ™•ξ™šξ™„ξ™•ξ™‡ξ™ˆξ™‡ξ˜ƒξ™—ξ™’ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜¦ξ™’ξ™‘ξ™‘ξ™ˆξ™†ξ™—ξ™Œξ™†ξ™˜ξ™—ξ˜ƒξ˜Άξ™—ξ™„ξ™—ξ™ˆξ˜ƒξ˜§ξ™ˆξ™“ξ™„ξ™•ξ™—ξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¨ξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ™‰ξ™•ξ™’ξ™ξ˜ƒξ™„ξ™“ξ˜
ξ™“ξ™ξ™Œξ™†ξ™„ξ™‘ξ™—ξ™–ξ˜ƒξ™šξ™Œξ™ξ™ξ˜ƒξ™’ξ™‘ξ™ξ™œξ˜ƒξ™…ξ™ˆξ˜ƒξ™„ξ™†ξ™†ξ™ˆξ™“ξ™—ξ™ˆξ™‡ξ˜ƒξ™šξ™‹ξ™ˆξ™‘ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™—ξ™ˆξ™–ξ™—ξ™Œξ™‘ξ™Šξ˜ƒξ™„ξ™Šξ™ˆξ™‘ξ™†ξ™œξ˜ƒξ™‘ξ™’ξ˜ƒξ™ξ™’ξ™‘ξ™Šξ™ˆξ™•ξ˜ƒξ™‹ξ™„ξ™–ξ˜ƒξ™œξ™’ξ™˜ξ™•ξ˜ƒξ™—ξ™ˆξ™–ξ™—ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ƒξ™’ξ™‘ξ˜ƒξšΏξ™ξ™ˆξ˜‘
ξ˜ξ˜ξ˜ƒ ξ˜¬ξ™‰ξ˜ƒξ™œξ™’ξ™˜ξ˜ƒξ™‹ξ™„ξ™™ξ™ˆξ˜ƒξ™—ξ™„ξ™Žξ™ˆξ™‘ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜Άξ˜€ξ˜·ξ˜’ξ˜€ξ˜¦ξ˜·ξ˜’ξ˜ͺξ˜΅ξ˜¨ξ˜ƒξ™’ξ™‘ξ˜ƒξ™ξ™’ξ™•ξ™ˆξ˜ƒξ™—ξ™‹ξ™„ξ™‘ξ˜ƒξ™’ξ™‘ξ™ˆξ˜ƒξ™’ξ™†ξ™†ξ™„ξ™–ξ™Œξ™’ξ™‘ξ˜ξ˜ƒξ™œξ™’ξ™˜ξ™•ξ˜ƒξ™‹ξ™Œξ™Šξ™‹ξ™ˆξ™–ξ™—ξ˜ƒξ™™ξ™ˆξ™•ξ™…ξ™„ξ™ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ™œξ™’ξ™˜ξ™•ξ˜ƒ
ξ™‹ξ™Œξ™Šξ™‹ξ™ˆξ™–ξ™—ξ˜ƒξ™ξ™„ξ™—ξ™‹ξ™ˆξ™ξ™„ξ™—ξ™Œξ™†ξ™–ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™šξ™Œξ™ξ™ξ˜ƒξ™…ξ™ˆξ˜ƒξ™†ξ™’ξ™ξ™…ξ™Œξ™‘ξ™ˆξ™‡ξ˜‘
TESTING AGENCY CONTACT LIST
Scholastic Aptitude Test (SAT) Scores
ξ˜·ξ™‹ξ™ˆξ˜ƒξ˜¦ξ™’ξ™ξ™ξ™ˆξ™Šξ™ˆξ˜ƒξ˜₯ξ™’ξ™„ξ™•ξ™‡ξ˜ƒξ™ξ™„ξ™Œξ™‘ξ™—ξ™„ξ™Œξ™‘ξ™–ξ˜ƒξ™‹ξ™Œξ™–ξ™—ξ™’ξ™•ξ™Œξ™†ξ™„ξ™ξ˜ƒξ˜Άξ˜€ξ˜·ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ƒξ™’ξ™‘ξ˜ƒξšΏξ™ξ™ˆξ˜‘ξ˜ƒξ˜ƒξ˜¬ξ™‘ξ™‰ξ™’ξ™•ξ™ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ™„ξ™…ξ™’ξ™˜ξ™—ξ˜ƒξ™’ξ™…ξ™—ξ™„ξ™Œξ™‘ξ™Œξ™‘ξ™Šξ˜ƒξ™‹ξ™Œξ™–ξ™—ξ™’ξ™•ξ™Œξ™†ξ™„ξ™ξ˜ƒξ˜Άξ˜€ξ˜·ξ˜ƒ
ξ™•ξ™ˆξ™–ξ™˜ξ™ξ™—ξ™–ξ˜ξ˜ƒξ™Œξ™‘ξ™†ξ™ξ™˜ξ™‡ξ™Œξ™‘ξ™Šξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™•ξ™ˆξ™”ξ™˜ξ™ˆξ™–ξ™—ξ˜ƒξ™‰ξ™’ξ™•ξ™ξ˜ξ˜ƒξ™Œξ™–ξ˜ƒξ™„ξ™™ξ™„ξ™Œξ™ξ™„ξ™…ξ™ξ™ˆξ˜ƒξ™’ξ™‘ξ™ξ™Œξ™‘ξ™ˆξ˜ƒξ™„ξ™—ξ˜ξ˜ƒwww.collegeboard.com/student/testing/
sat/scores/sending.htmlξ˜ƒξ™’ξ™•ξ˜ƒξ™†ξ™„ξ™ξ™ξ˜ξ˜ƒξ˜›ξ˜™ξ˜™ξ˜ξ˜šξ˜˜ξ˜™ξ˜ξ˜šξ˜–ξ˜—ξ˜™ξ˜‘ξ˜ƒξ˜ƒξ˜·ξ™‹ξ™ˆξ˜ƒξ˜³ξ™•ξ™’ξ™Šξ™•ξ™„ξ™ξ˜ƒξ˜¦ξ™’ξ™‡ξ™ˆξ˜ƒξ™‰ξ™’ξ™•ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜¦ξ™’ξ™‘ξ™‘ξ™ˆξ™†ξ™—ξ™Œξ™†ξ™˜ξ™—ξ˜ƒξ˜Άξ™—ξ™„ξ™—ξ™ˆξ˜ƒξ˜§ξ™ˆξ™“ξ™„ξ™•ξ™—ξ˜
ment of Education is 3132ξ˜‘
ξ˜°ξ™„ξ™Œξ™ξ˜ƒξ™œξ™’ξ™˜ξ™•ξ˜ƒξ™†ξ™’ξ™ξ™“ξ™ξ™ˆξ™—ξ™ˆξ™‡ξ˜ƒξ™‰ξ™’ξ™•ξ™ξ˜ƒξ™—ξ™’ξ˜
SAT Program
P.O. Box 8057
Mt. Vernon, IL 62864
American College Testing (ACT) Scores
ξ˜·ξ™‹ξ™ˆξ˜ƒξ˜€ξ˜¦ξ˜·ξ˜ƒξ™ξ™„ξ™Œξ™‘ξ™—ξ™„ξ™Œξ™‘ξ™–ξ˜ƒξ™‹ξ™Œξ™–ξ™—ξ™’ξ™•ξ™Œξ™†ξ™„ξ™ξ˜ƒξ˜€ξ˜¦ξ˜·ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ƒξ™’ξ™‘ξ˜ƒξšΏξ™ξ™ˆξ˜‘ξ˜ƒξ˜ƒξ˜¬ξ™‘ξ™‰ξ™’ξ™•ξ™ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ™„ξ™…ξ™’ξ™˜ξ™—ξ˜ƒξ™•ξ™ˆξ™“ξ™’ξ™•ξ™—ξ™Œξ™‘ξ™Šξ˜ƒξ™‹ξ™Œξ™–ξ™—ξ™’ξ™•ξ™Œξ™†ξ™„ξ™ξ˜ƒξ˜€ξ˜¦ξ˜·ξ˜ƒξ™•ξ™ˆξ™–ξ™˜ξ™ξ™—ξ™–ξ˜ξ˜ƒ
ξ™Œξ™‘ξ™†ξ™ξ™˜ξ™‡ξ™Œξ™‘ξ™Šξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™•ξ™ˆξ™”ξ™˜ξ™ˆξ™–ξ™—ξ˜ƒξ™‰ξ™’ξ™•ξ™ξ˜ξ˜ƒξ™Œξ™–ξ˜ƒξ™„ξ™™ξ™„ξ™Œξ™ξ™„ξ™…ξ™ξ™ˆξ˜ƒξ™’ξ™‘ξ™ξ™Œξ™‘ξ™ˆξ˜ƒξ™„ξ™—ξ˜ξ˜ƒwww.actstudent.org/scoresξ˜ƒξ™’ξ™•ξ˜ƒξ™†ξ™„ξ™ξ™ξ˜ξ˜ƒξ˜ƒ
ξ˜–ξ˜”ξ˜œξ˜ξ˜–ξ˜–ξ˜šξ˜ξ˜”ξ˜–ξ˜”ξ˜–ξ˜‘ξ˜ƒξ˜ƒξ˜·ξ™‹ξ™ˆξ˜ƒξ˜€ξ˜¦ξ˜·ξ˜ƒξ˜¦ξ™’ξ™‡ξ™ˆξ˜ƒξ™‰ξ™’ξ™•ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜¦ξ™’ξ™‘ξ™‘ξ™ˆξ™†ξ™—ξ™Œξ™†ξ™˜ξ™—ξ˜ƒξ˜Άξ™—ξ™„ξ™—ξ™ˆξ˜ƒξ˜§ξ™ˆξ™“ξ™„ξ™•ξ™—ξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¨ξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ™Œξ™–ξ˜ƒ0625ξ˜‘
ξ˜°ξ™„ξ™Œξ™ξ˜ƒξ™œξ™’ξ™˜ξ™•ξ˜ƒξ™†ξ™’ξ™ξ™“ξ™ξ™ˆξ™—ξ™ˆξ™‡ξ˜ƒξ™‰ξ™’ξ™•ξ™ξ˜ƒξ™—ξ™’ξ˜
ACT Records
P.O. Box 451
Iowa City, IA 52243-0451
Graduate Record Examination (GRE) Scores
ξ˜·ξ™‹ξ™ˆξ˜ƒξ˜¨ξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ™„ξ™ξ˜ƒξ˜·ξ™ˆξ™–ξ™—ξ™Œξ™‘ξ™Šξ˜ƒξ˜Άξ™ˆξ™•ξ™™ξ™Œξ™†ξ™ˆξ˜ƒξ˜‹ξ˜¨ξ˜·ξ˜Άξ˜Œξ˜ƒξ™•ξ™ˆξ™—ξ™„ξ™Œξ™‘ξ™–ξ˜ƒξ™Œξ™‘ξ™‡ξ™Œξ™™ξ™Œξ™‡ξ™˜ξ™„ξ™ξ˜ƒξ˜ͺξ˜΅ξ˜¨ξ˜ƒξ™—ξ™ˆξ™–ξ™—ξ˜ƒξ™•ξ™ˆξ™†ξ™’ξ™•ξ™‡ξ™–ξ˜ƒξ™‰ξ™’ξ™•ξ˜ƒξ™„ξ˜ƒξ™“ξ™ˆξ™•ξ™Œξ™’ξ™‡ξ˜ƒξ™’ξ™‰ξ˜ƒξšΏξ™™ξ™ˆξ˜ƒξ™œξ™ˆξ™„ξ™•ξ™–ξ˜‘ξ˜ƒξ˜ƒξ˜¬ξ™‰ξ˜ƒ
ξ™œξ™’ξ™˜ξ˜ƒξ™‹ξ™„ξ™™ξ™ˆξ˜ƒξ™—ξ™„ξ™Žξ™ˆξ™‘ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜ͺξ˜΅ξ˜¨ξ˜ƒξ™šξ™Œξ™—ξ™‹ξ™Œξ™‘ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™“ξ™„ξ™–ξ™—ξ˜ƒξšΏξ™™ξ™ˆξ˜ƒξ™œξ™ˆξ™„ξ™•ξ™–ξ˜ξ˜ƒξ™“ξ™ξ™ˆξ™„ξ™–ξ™ˆξ˜ƒξ™†ξ™’ξ™‘ξ™—ξ™„ξ™†ξ™—ξ˜ƒξ˜¨ξ˜·ξ˜Άξ˜ƒξ™’ξ™‘ξ™ξ™Œξ™‘ξ™ˆξ˜ƒξ™„ξ™—ξ˜ξ˜ƒwww.gre.orgξ˜ƒξ™’ξ™•ξ˜ƒξ™†ξ™„ξ™ξ™ξ˜ξ˜ƒ
ξ˜›ξ˜›ξ˜›ξ˜ξ˜—ξ˜šξ˜–ξ˜ξ˜šξ˜•ξ˜™ξ˜šξ˜‘ξ˜ƒξ˜ƒξ˜²ξ™•ξ™Œξ™Šξ™Œξ™‘ξ™„ξ™ξ˜ƒξ™•ξ™ˆξ™“ξ™’ξ™•ξ™—ξ™–ξ˜ƒξ™ξ™˜ξ™–ξ™—ξ˜ƒξ™…ξ™ˆξ˜ƒξ™’ξ™•ξ™‡ξ™ˆξ™•ξ™ˆξ™‡ξ˜ƒξ™‰ξ™•ξ™’ξ™ξ˜ƒξ˜¨ξ˜·ξ˜Άξ˜‘ξ˜ƒξ˜°ξ™„ξ™Œξ™ξ˜ƒξ™œξ™’ξ™˜ξ™•ξ˜ƒξ™†ξ™’ξ™ξ™“ξ™ξ™ˆξ™—ξ™ˆξ™‡ξ˜ƒξ™‰ξ™’ξ™•ξ™ξ˜ƒξ™—ξ™’ξ˜ƒξ˜¨ξ˜·ξ˜Άξ˜ξ˜€ξ˜Άξ˜΅ξ˜’
ξ˜ͺξ˜΅ξ˜¨ξ˜ξ˜ƒξ˜₯ξ™’ξ™›ξ˜ƒξ˜–ξ˜šξ˜”ξ˜—ξ˜™ξ˜–ξ˜ξ˜ƒξ˜³ξ™Œξ™—ξ™—ξ™–ξ™…ξ™˜ξ™•ξ™Šξ™‹ξ˜ξ˜ƒξ˜³ξ˜€ξ˜ƒξ˜”ξ˜˜ξ˜•ξ˜˜ξ˜“ξ˜ξ˜šξ˜—ξ˜™ξ˜–
ξ˜‘
Upon receipt forward the originalξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™•ξ™ˆξ™“ξ™’ξ™•ξ™—ξ˜ƒξ™—ξ™’ξ˜
ξ˜₯ξ™˜ξ™•ξ™ˆξ™„ξ™˜ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¨ξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™’ξ™•ξ˜ƒξ˜Άξ™—ξ™„ξ™‘ξ™‡ξ™„ξ™•ξ™‡ξ™–ξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ˜¦ξ™ˆξ™•ξ™—ξ™ŒξšΏξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘
Waiver Coordinator
P.O. Box 150471, Room 243
Hartford, CT 06115-0471
ξ˜¦ξ™„ξ™‘ξ™‡ξ™Œξ™‡ξ™„ξ™—ξ™ˆξ™–ξ˜ƒξ™šξ™‹ξ™’ξ˜ƒξ™—ξ™’ξ™’ξ™Žξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜ͺξ˜΅ξ˜¨ξ˜ƒξ™ξ™’ξ™•ξ™ˆξ˜ƒξ™—ξ™‹ξ™„ξ™‘ξ˜ƒξšΏξ™™ξ™ˆξ˜ƒξ™œξ™ˆξ™„ξ™•ξ™–ξ˜ƒξ™„ξ™Šξ™’ξ˜ƒξ™ξ™˜ξ™–ξ™—ξ˜ƒξ™–ξ™˜ξ™…ξ™ξ™Œξ™—ξ˜ƒξ™„ξ™‘ξ˜ƒξ™’ξ™‰ξšΏξ™†ξ™Œξ™„ξ™ξ˜ƒξ™—ξ™•ξ™„ξ™‘ξ™–ξ™†ξ™•ξ™Œξ™“ξ™—ξ˜ƒξ™–ξ™‹ξ™’ξ™šξ™Œξ™‘ξ™Šξ˜ƒξ™—ξ™‹ξ™ˆξ™Œξ™•ξ˜ƒ
ξ˜ͺξ˜΅ξ˜¨ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ξ˜ƒξ™’ξ™•ξ˜ƒξ™„ξ™‘ξ˜ƒξ™’ξ™•ξ™Œξ™Šξ™Œξ™‘ξ™„ξ™ξ˜ƒξ™‡ξ™’ξ™†ξ™˜ξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ™’ξ™‰ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜ͺξ˜΅ξ˜¨ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™•ξ™ˆξ™“ξ™’ξ™•ξ™—ξ˜ƒξ™–ξ™ˆξ™‘ξ™—ξ˜ƒξ™—ξ™’ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™†ξ™„ξ™‘ξ™‡ξ™Œξ™‡ξ™„ξ™—ξ™ˆξ˜ƒξ™šξ™Œξ™—ξ™‹ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜¦ξ™’ξ™‘ξ™‘ξ™ˆξ™†ξ™—ξ™Œξ™†ξ™˜ξ™—ξ˜ƒ
ξ˜€ξ™†ξ™„ξ™‡ξ™ˆξ™ξ™Œξ™†ξ˜ƒξ˜Άξ™Žξ™Œξ™ξ™ξ™–ξ˜ƒξ˜€ξ™–ξ™–ξ™ˆξ™–ξ™–ξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ˜Ίξ™„ξ™Œξ™™ξ™ˆξ™•ξ˜ƒξ˜€ξ™“ξ™“ξ™ξ™Œξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ™‰ξ™’ξ™•ξ™ξ˜ƒξ˜‹ξ˜¨ξ˜§ξ˜ƒξ˜”ξ˜œξ˜•ξ˜Œξ˜‘
PAGE 3
Connecticut State Department of Education
APPLICATION FOR CONNECTICUT ACADEMIC SKILLS ASSESSMENT WAIVER
Prueba de Aptitud Academica (PAA) Score Request
ξ˜·ξ™‹ξ™Œξ™–ξ˜ƒξ™‰ξ™’ξ™•ξ™ξ˜ƒξ™–ξ™‹ξ™’ξ™˜ξ™ξ™‡ξ˜ƒξ™…ξ™ˆξ˜ƒξ™†ξ™’ξ™ξ™“ξ™ξ™ˆξ™—ξ™ˆξ™‡ξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ™ξ™„ξ™Œξ™ξ™ˆξ™‡ξ˜ƒξ™—ξ™’ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜¦ξ™’ξ™ξ™ξ™ˆξ™Šξ™ˆξ˜ƒξ˜₯ξ™’ξ™„ξ™•ξ™‡ξ˜ƒξ™Œξ™‘ξ˜ƒξ˜³ξ™˜ξ™ˆξ™•ξ™—ξ™’ξ˜ƒξ˜΅ξ™Œξ™†ξ™’ξ˜ƒξ˜²ξ˜±ξ˜―ξ˜Όξ˜ƒξ™Œξ™‰ξ˜ƒξ™œξ™’ξ™˜ξ˜ƒξ™•ξ™ˆξ™†ξ™ˆξ™Œξ™™ξ™ˆξ™‡ξ˜ƒξ™„ξ˜ƒξ™—ξ™’ξ™—ξ™„ξ™ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™’ξ™‘ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒ
ξ˜³ξ˜€ξ˜€ξ˜ƒξ™ˆξ™”ξ™˜ξ™Œξ™™ξ™„ξ™ξ™ˆξ™‘ξ™—ξ˜ξ˜ƒξ™—ξ™’ξ˜ƒξ™„ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™’ξ™‰ξ˜ƒξ˜”ξ˜“ξ˜“ξ˜“ξ˜ƒξ™’ξ™‘ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜Άξ™†ξ™‹ξ™’ξ™ξ™„ξ™–ξ™—ξ™Œξ™†ξ˜ƒξ˜€ξ™“ξ™—ξ™Œξ™—ξ™˜ξ™‡ξ™ˆξ˜ƒξ˜·ξ™ˆξ™–ξ™—ξ˜ƒξ˜‹ξ˜Άξ˜€ξ˜·ξ˜Œξ˜ξ˜ƒξ™šξ™Œξ™—ξ™‹ξ˜ƒξ™‘ξ™ˆξ™Œξ™—ξ™‹ξ™ˆξ™•ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™ξ™„ξ™—ξ™‹ξ™ˆξ™ξ™„ξ™—ξ™Œξ™†ξ™–ξ˜ƒξ™‘ξ™’ξ™•ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™™ξ™ˆξ™•ξ™…ξ™„ξ™ξ˜ƒξ™–ξ™˜ξ™…ξ˜
ξ™—ξ™ˆξ™–ξ™—ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™…ξ™ˆξ™ξ™’ξ™šξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™ˆξ™”ξ™˜ξ™Œξ™™ξ™„ξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜—ξ˜“ξ˜“ξ˜ƒξ™“ξ™’ξ™Œξ™‘ξ™—ξ™–ξ˜‘ξ˜ƒξ˜ƒξ˜€ξ™ξ™–ξ™’ξ˜ξ˜ƒξ™„ξ˜ƒξ™ξ™Œξ™‘ξ™Œξ™ξ™˜ξ™ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™’ξ™‰ξ˜ƒξ˜˜ξ˜”ξ˜“ξ˜ƒξ™’ξ™‘ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜¨ξ™‘ξ™Šξ™ξ™Œξ™–ξ™‹ξ˜ξ™„ξ™–ξ˜ξ™„ξ˜ξ˜Άξ™ˆξ™†ξ™’ξ™‘ξ™‡ξ˜ξ˜―ξ™„ξ™‘ξ™Šξ™˜ξ™„ξ™Šξ™ˆξ˜ƒξ˜€ξ™†ξ™‹ξ™Œξ™ˆξ™™ξ™ˆξ˜
ξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ˜·ξ™ˆξ™–ξ™—ξ˜ƒξ˜‹ξ˜¨ξ˜Άξ˜―ξ˜€ξ˜·ξ˜Œξ˜ƒξ™’ξ™•ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜·ξ™ˆξ™–ξ™—ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¨ξ™‘ξ™Šξ™ξ™Œξ™–ξ™‹ξ˜ƒξ™„ξ™–ξ˜ƒξ™„ξ˜ƒξ˜©ξ™’ξ™•ξ™ˆξ™Œξ™Šξ™‘ξ˜ƒξ˜―ξ™„ξ™‘ξ™Šξ™˜ξ™„ξ™Šξ™ˆξ˜ƒξ˜‹ξ˜·ξ˜²ξ˜¨ξ˜©ξ˜―ξ˜Œξ˜ƒξ™Œξ™–ξ˜ƒξ™•ξ™ˆξ™”ξ™˜ξ™Œξ™•ξ™ˆξ™‡ξ˜‘
ξ˜¬ξ˜ƒξ™‰ξ™’ξ™•ξ™ξ™„ξ™ξ™ξ™œξ˜ƒξ™•ξ™ˆξ™”ξ™˜ξ™ˆξ™–ξ™—ξ˜ƒξ™—ξ™‹ξ™„ξ™—ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜¦ξ™’ξ™ξ™ξ™ˆξ™Šξ™ˆξ˜ƒξ˜₯ξ™’ξ™„ξ™•ξ™‡ξ˜ξ˜ƒξ˜³ξ™˜ξ™ˆξ™•ξ™—ξ™’ξ˜ƒξ˜΅ξ™Œξ™†ξ™’ξ˜ƒξ˜²ξ™‰ξšΏξ™†ξ™ˆξ˜ξ˜ƒξ™‰ξ™’ξ™•ξ™šξ™„ξ™•ξ™‡ξ˜ƒξ™ξ™œξ˜ƒξ˜³ξ˜€ξ˜€ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ƒξ™—ξ™’ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒConnecticut State
ξ˜§ξ™ˆξ™“ξ™„ξ™•ξ™—ξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¨ξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ξ˜ƒξ˜₯ξ™˜ξ™•ξ™ˆξ™„ξ™˜ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¨ξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™’ξ™•ξ˜ƒξ˜Άξ™—ξ™„ξ™‘ξ™‡ξ™„ξ™•ξ™‡ξ™–ξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ˜¦ξ™ˆξ™•ξ™—ξ™ŒξšΏξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜‘ξ˜ƒξ˜ƒ
PLEASE PRINT LEGIBLY AND PROVIDE AS MUCH INFORMATION AS POSSIBLE
The following information will facilitate this request.
Social Security Number: Name at time of testing:
Date of Birth: Current Name (If different from above):
Gender:
High School Attended:
Current Mailing Address:
ξ˜Άξ™—ξ™•ξ™ˆξ™ˆξ™—ξ˜ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜¦ξ™Œξ™—ξ™œξ˜’ξ˜·ξ™’ξ™šξ™‘ξ˜ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜Άξ™—ξ™„ξ™—ξ™ˆξ˜ξ˜ƒ ξ˜ƒ ξ˜½ξ™Œξ™“ξ˜
ξ˜³ξ™‹ξ™’ξ™‘ξ™ˆξ˜ƒξ˜±ξ™˜ξ™ξ™…ξ™ˆξ™•ξ˜
Date/Location of administration for which score report is requested:
ξ˜·ξ™ˆξ™–ξ™—ξ˜ƒξ˜§ξ™„ξ™—ξ™ˆξ˜ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜·ξ™ˆξ™–ξ™—ξ˜ƒξ˜¦ξ™ˆξ™‘ξ™—ξ™ˆξ™•ξ˜
Please mail my PAA score report to:
ξ˜¦ξ˜²ξ˜±ξ˜±ξ˜¨ξ˜¦ξ˜·ξ˜¬ξ˜¦ξ˜Έξ˜·ξ˜ƒξ˜Άξ˜·ξ˜€ξ˜·ξ˜¨ξ˜ƒξ˜§ξ˜¨ξ˜³ξ˜€ξ˜΅ξ˜·ξ˜°ξ˜¨ξ˜±ξ˜·ξ˜ƒξ˜²ξ˜©ξ˜ƒξ˜¨ξ˜§ξ˜Έξ˜¦ξ˜€ξ˜·ξ˜¬ξ˜²ξ˜±
ξ˜₯ξ™˜ξ™•ξ™ˆξ™„ξ™˜ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¨ξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™’ξ™•ξ˜ƒξ˜Άξ™—ξ™„ξ™‘ξ™‡ξ™„ξ™•ξ™‡ξ™–ξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ˜¦ξ™ˆξ™•ξ™—ξ™ŒξšΏξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘
Waiver Coordinator
ξ˜³ξ˜‘ξ˜²ξ˜‘ξ˜ƒξ˜₯ξ™’ξ™›ξ˜ƒξ˜”ξ˜˜ξ˜“ξ˜—ξ˜šξ˜”ξ˜ƒξ˜ξ˜ƒξ˜΅ξ™’ξ™’ξ™ξ˜ƒξ˜•ξ˜—ξ˜–
ξ˜«ξ™„ξ™•ξ™—ξ™‰ξ™’ξ™•ξ™‡ξ˜ξ˜ƒξ˜¦ξ˜·ξ˜ƒξ˜ƒξ˜“ξ˜™ξ˜”ξ˜”ξ˜˜ξ˜ξ˜“ξ˜—ξ˜šξ˜”
ξ˜Άξ™Œξ™Šξ™‘ξ™„ξ™—ξ™˜ξ™•ξ™ˆξ˜ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜ƒ ξ˜§ξ™„ξ™—ξ™ˆξ˜
ξ˜ξ˜΅ξ™ˆξ™‰ξ™ˆξ™•ξ˜ƒξ™—ξ™’ξ˜ƒξ˜€ξ™…ξ™…ξ™•ξ™ˆξ™™ξ™Œξ™„ξ™—ξ™ˆξ™‡ξ˜ƒξ˜¨ξ™”ξ™˜ξ™Œξ™™ξ™„ξ™ξ™ˆξ™‘ξ™†ξ™œξ˜ƒξ˜·ξ™„ξ™…ξ™ξ™ˆξ˜ƒξ˜”ξ˜‘ξ˜ƒξ˜ƒξ˜¨ξ™”ξ™˜ξ™Œξ™™ξ™„ξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ˜Άξ˜€ξ˜·ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ƒξ™„ξ™•ξ™ˆξ˜ƒξ™‡ξ™ˆξ™—ξ™ˆξ™•ξ™ξ™Œξ™‘ξ™ˆξ™‡ξ˜ƒξ™‰ξ™•ξ™’ξ™ξ˜ƒξ™„ξ™‘ξ˜ƒξ™ˆξ™›ξ™“ξ™„ξ™‘ξ™‡ξ™ˆξ™‡ξ˜ƒξ™—ξ™„ξ™…ξ™ξ™ˆξ˜‘
Important: ξ˜³ξ™ξ™ˆξ™„ξ™–ξ™ˆξ˜ƒξ™†ξ™’ξ™‘ξ™—ξ™„ξ™†ξ™—ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜¦ξ™’ξ™ξ™ξ™ˆξ™Šξ™ˆξ˜ƒξ˜₯ξ™’ξ™„ξ™•ξ™‡ξ˜ƒξ™‰ξ™’ξ™•ξ˜ƒξ™†ξ™˜ξ™•ξ™•ξ™ˆξ™‘ξ™—ξ˜ƒξ™Œξ™‘ξ™‰ξ™’ξ™•ξ™ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ™’ξ™‘ξ˜ƒξ™‰ξ™ˆξ™ˆξ™–ξ˜ƒξ™‰ξ™’ξ™•ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™•ξ™ˆξ™“ξ™’ξ™•ξ™—ξ™Œξ™‘ξ™Šξ˜
COLLEGE BOARD
ξ˜²ξšΏξ™†ξ™Œξ™‘ξ™„ξ˜ƒξ™‡ξ™ˆξ˜ƒξ˜³ξ™˜ξ™ˆξ™•ξ™—ξ™’ξ˜ƒξ˜΅ξ™Œξ™†ξ™’ξ˜ƒξ™œξ˜ƒξ˜€ξ™ξ™°ξ™•ξ™Œξ™†ξ™„ξ˜ƒξ˜―ξ™„ξ™—ξ™Œξ™‘ξ™„
P.O. Box 71101
San Juan, PR 00936-8001
Phone: 787-772-1200
Fax: 787-759-8629
Website: http://oprla.collegeboard.com
PAGE 4
ED 192 – TABLE 1
ABBREVIATED CONVERSION TABLE EQUATING PAA SCALED SCORES TO SAT SCORES
800
787
774
761
749
736
723
710
697
684
672
659
646
633
625
617
609
601
592
584
576
568
560
552
544
535
527
519
511
503
495
487
478
470
785
757
709
660
617
584
557
535
516
500
485
472
460
449
438
428
419
410
401
393
384
376
369
361
354
347
340
333
326
319
313
307
301
295
462
454
446
438
430
421
413
405
397
389
381
373
364
356
348
340
332
324
316
307
299
291
283
275
267
259
250
242
234
226
218
210
202
200
289
283
278
272
267
262
257
252
248
243
238
234
229
225
221
216
212
208
204
200
196
192
188
184
180
176
172
168
163
158
155
152
150
148
800
790
779
768
758
747
736
726
715
704
694
683
672
662
651
640
630
619
608
598
587
576
566
555
544
534
523
512
502
491
480
470
459
448
785
743
676
629
593
564
539
518
499
482
467
453
440
429
418
408
399
390
382
374
366
359
353
346
340
334
329
323
318
313
308
303
299
295
438
427
416
406
395
384
374
363
352
342
331
320
310
299
288
278
267
256
246
235
224
214
203
200
290
286
282
278
274
269
265
261
257
253
249
245
241
237
232
228
224
220
216
212
209
205
197
188
VERBAL
MATHEMATICAL
Equivalent
SAT – Verbal
Score
PAA – Verbal
Score
PAA – Verbal
Score
Equivalent
SAT – Verbal
Score
Equivalent
SAT – Math
Score
PAA – Math
Score
PAA – Math
Score
Equivalent
SAT – Math
Score
PAGE 5
Note: The lowest score reported on both the PAA and SAT is 200.
Equivalent scores are based upon the equivalency table developed by William H. Angoff and Linda L. Cook, reported in Angoff, W.H. and Cook, L.L (1988).
β€œEquating the Scales of the Spanish-Language Prueba de Aptitud Academica and the English-Language Scholastic Aptitude Test of College Entrance
Examination Board.” Princeton, NJ: Educational Testing Service.
ED 192 – INSTRUCTIONS
REV. 12/11
C.G.S. 10-145f
HOW TO APPLY FOR A CONNECTICUT ACADEMIC SKILLS ASSESSMENT WAIVER
ξ˜”ξ˜‘ξ˜ƒ ξ˜¦ξ™’ξ™ξ™“ξ™ξ™ˆξ™—ξ™ˆξ˜ƒξ™‰ξ™’ξ™•ξ™ξ˜ƒξ˜¨ξ˜§ξ˜ƒξ˜”ξ˜œξ˜•ξ˜ƒξš±ξ˜ƒξš³ξ˜€ξ™“ξ™“ξ™ξ™Œξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ˜©ξ™’ξ™•ξ˜ƒξ˜¦ξ™’ξ™‘ξ™‘ξ™ˆξ™†ξ™—ξ™Œξ™†ξ™˜ξ™—ξ˜ƒξ˜€ξ™†ξ™„ξ™‡ξ™ˆξ™ξ™Œξ™†ξ˜ƒξ˜Άξ™Žξ™Œξ™ξ™ξ™–ξ˜ƒξ˜€ξ™–ξ™–ξ™ˆξ™–ξ™–ξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ˜Ίξ™„ξ™Œξ™™ξ™ˆξ™•ξ˜‘ξš΄
ξ˜•ξ˜‘ξ˜ƒ ξ˜°ξ™„ξ™Œξ™ξ˜ƒξ˜³ξ™„ξ™Šξ™ˆξ˜ƒξ˜”ξ˜ƒξ™’ξ™‰ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™†ξ™’ξ™ξ™“ξ™ξ™ˆξ™—ξ™ˆξ™‡ξ˜ƒξ™‰ξ™’ξ™•ξ™ξ˜ƒξ˜‹ξ˜¨ξ˜§ξ˜ƒξ˜”ξ˜œξ˜•ξ˜Œξ˜ƒξ™—ξ™’ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™„ξ™‡ξ™‡ξ™•ξ™ˆξ™–ξ™–ξ˜ƒξ™…ξ™ˆξ™ξ™’ξ™šξ˜‘ξ˜ƒ
ξ˜–ξ˜‘ξ˜ƒ ξ˜¦ξ™’ξ™‘ξ™—ξ™„ξ™†ξ™—ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™•ξ™ˆξ™–ξ™“ξ™ˆξ™†ξ™—ξ™Œξ™™ξ™ˆξ˜ƒξ™—ξ™ˆξ™–ξ™—ξ™Œξ™‘ξ™Šξ˜ƒξ™†ξ™’ξ™ξ™“ξ™„ξ™‘ξ™œξ˜ƒξ˜‹ξ˜Άξ˜€ξ˜·ξ˜ξ˜ƒξ˜€ξ˜¦ξ˜·ξ˜ξ˜ƒξ˜ͺξ˜΅ξ˜¨ξ˜ƒξ™’ξ™•ξ˜ƒξ˜³ξ˜€ξ˜€ξ˜Œξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ™‹ξ™„ξ™™ξ™ˆξ˜ƒξ™œξ™’ξ™˜ξ™•ξ˜ƒξ™—ξ™ˆξ™–ξ™—ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ƒξ™•ξ™ˆξ™“ξ™’ξ™•ξ™—ξ™ˆξ™‡ξ˜ƒ
ξ™—ξ™’ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜¦ξ™’ξ™‘ξ™‘ξ™ˆξ™†ξ™—ξ™Œξ™†ξ™˜ξ™—ξ˜ƒξ˜Άξ™—ξ™„ξ™—ξ™ˆξ˜ƒξ˜§ξ™ˆξ™“ξ™„ξ™•ξ™—ξ™ξ™ˆξ™‘ξ™—ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¨ξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘ξ˜ƒξ˜‹ξ˜¦ξ˜Άξ˜§ξ˜¨ξ˜Œξ˜‘ξ˜ƒξ˜ƒξ˜Άξ™ˆξ™ˆξ˜ƒξ™†ξ™’ξ™‘ξ™—ξ™„ξ™†ξ™—ξ˜ƒξ™ξ™Œξ™–ξ™—ξ˜ƒξ™’ξ™‘ξ˜ƒξ˜³ξ™„ξ™Šξ™ˆξ˜ƒξ˜–ξ˜‘ξ˜ƒξ˜·ξ™ˆξ™–ξ™—ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ˜ƒξ™•ξ™ˆξ˜
ξ™“ξ™’ξ™•ξ™—ξ™–ξ˜ƒξ™‰ξ™’ξ™•ξ™šξ™„ξ™•ξ™‡ξ™ˆξ™‡ξ˜ƒξ™—ξ™’ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜¦ξ˜Άξ˜§ξ˜¨ξ˜ƒξ™‰ξ™•ξ™’ξ™ξ˜ƒξ™šξ™„ξ™Œξ™™ξ™ˆξ™•ξ˜ƒξ™„ξ™“ξ™“ξ™ξ™Œξ™†ξ™„ξ™‘ξ™—ξ™–ξ˜ƒξ™šξ™Œξ™ξ™ξ˜ƒξ™’ξ™‘ξ™ξ™œξ˜ƒξ™…ξ™ˆξ˜ƒξ™„ξ™†ξ™†ξ™ˆξ™“ξ™—ξ™ˆξ™‡ξ˜ƒξ™šξ™‹ξ™ˆξ™‘ξ˜ƒξ™„ξ˜ƒξ™—ξ™ˆξ™–ξ™—ξ™Œξ™‘ξ™Šξ˜ƒξ™„ξ™Šξ™ˆξ™‘ξ™†ξ™œξ˜ƒξ™‘ξ™’ξ˜ƒ
ξ™ξ™’ξ™‘ξ™Šξ™ˆξ™•ξ˜ƒξ™‹ξ™„ξ™–ξ˜ƒξ™œξ™’ξ™˜ξ™•ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ƒξ™’ξ™‘ξ˜ƒξšΏξ™ξ™ˆξ˜‘ξ˜ƒξ˜³ξ™ξ™ˆξ™„ξ™–ξ™ˆξ˜ƒξ™‘ξ™’ξ™—ξ™ˆξ˜ƒξ™—ξ™‹ξ™„ξ™—ξ˜ƒξ™Œξ™—ξ˜ƒξ™ξ™„ξ™œξ˜ƒξ™—ξ™„ξ™Žξ™ˆξ˜ƒξ™˜ξ™“ξ˜ƒξ™—ξ™’ξ˜ƒξ™–ξ™Œξ™›ξ˜ƒξ™šξ™ˆξ™ˆξ™Žξ™–ξ˜ƒξ™‰ξ™’ξ™•ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ™—ξ™ˆξ™–ξ™—ξ™Œξ™‘ξ™Šξ˜ƒξ™†ξ™’ξ™ξ™“ξ™„ξ™‘ξ™œξ˜ƒξ™—ξ™’ξ˜ƒ
ξ™Šξ™ˆξ™—ξ˜ƒξ™œξ™’ξ™˜ξ™•ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ƒξ™—ξ™’ξ˜ƒξ™—ξ™‹ξ™ˆξ˜ƒξ˜¦ξ˜Άξ˜§ξ˜¨ξ˜‘
ξ˜—ξ˜‘ξ˜ƒ ξ˜Έξ™“ξ™’ξ™‘ξ˜ƒξ™•ξ™ˆξ™†ξ™ˆξ™Œξ™“ξ™—ξ˜ƒξ™’ξ™‰ξ˜ƒξ™œξ™’ξ™˜ξ™•ξ˜ƒξ˜¨ξ˜§ξ˜ƒξ˜”ξ˜œξ˜•ξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ™œξ™’ξ™˜ξ™•ξ˜ƒξ˜Άξ˜€ξ˜·ξ˜’ξ˜€ξ˜¦ξ˜·ξ˜’ξ˜ͺξ˜΅ξ˜¨ξ˜’ξ˜³ξ˜€ξ˜€ξ˜ƒξ™–ξ™†ξ™’ξ™•ξ™ˆξ™–ξ˜ξ˜ƒξ™œξ™’ξ™˜ξ˜ƒξ™šξ™Œξ™ξ™ξ˜ƒξ™…ξ™ˆξ˜ƒξ™ξ™„ξ™Œξ™ξ™ˆξ™‡ξ˜ƒξ™šξ™•ξ™Œξ™—ξ™—ξ™ˆξ™‘ξ˜ƒξ™™ξ™ˆξ™•ξ™Œξ˜
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ξ™“ξ™‹ξ™’ξ™‘ξ™ˆξ˜ξ˜ƒξ™‰ξ™„ξ™›ξ˜ƒξ™’ξ™•ξ˜ƒξ™ˆξ™ξ™„ξ™Œξ™ξ˜
CONNECTICUT STATE DEPARTMENT OF EDUCATION
ξ˜₯ξ™˜ξ™•ξ™ˆξ™„ξ™˜ξ˜ƒξ™’ξ™‰ξ˜ƒξ˜¨ξ™‡ξ™˜ξ™†ξ™„ξ™—ξ™’ξ™•ξ˜ƒξ˜Άξ™—ξ™„ξ™‘ξ™‡ξ™„ξ™•ξ™‡ξ™–ξ˜ƒξ™„ξ™‘ξ™‡ξ˜ƒξ˜¦ξ™ˆξ™•ξ™—ξ™ŒξšΏξ™†ξ™„ξ™—ξ™Œξ™’ξ™‘
Waiver Coordinator
P.O. Box 150471 – Room 243
Hartford, CT 06115-0471
Phone: 860-713-6969; Fax: 860-713-7017
Email: teacher[email protected]
Website: www.ct.gov/sde
PAGE 6

Form Information

Fact Name Details
Form Purpose The ED 192 form is an application for a waiver of the Connecticut Academic Skills Assessment, which is required for prospective educators.
Governing Law This form is governed by Connecticut General Statutes Section 10-145f.
Submission Requirements Applicants must submit a completed form along with an official score report. Scores sent by candidates will not be accepted.
Personal Information Applicants must provide personal details, including name, Social Security number, address, and gender.
Testing Options Waivers can be granted based on SAT, ACT, GRE, or PAA scores that meet specific criteria.
Score Reporting Official score reports must be sent directly from the testing agency to the Connecticut State Department of Education.
Eligibility Criteria Individuals seeking admission to educator preparation programs or certification in Connecticut must fulfill academic skills requirements.
Application Processing The application will not be processed until all required documents are received by the Bureau of Educator Standards and Certification.

Detailed Guide for Filling Out Connecticut Ed 192

To complete the Connecticut Ed 192 form, follow these steps carefully. Ensure that all required information is filled out accurately before submitting your application. Incomplete forms may delay the processing of your waiver request.

  1. Obtain the Connecticut Ed 192 form from the Connecticut State Department of Education website or your educational institution.
  2. Print the form in blue ink and use uppercase letters for clarity.
  3. Fill in your personal information:
    • Last Name
    • First Name
    • Middle Initial (MI)
    • Social Security Number
    • Address (Street, City, State, Zip Code)
    • Former Last Name(s) (if applicable)
    • Phone Number (Home and Work)
    • Email Address
    • Gender (M/F)
    • Date of Birth (Month-Day-Year)
  4. Select your race/ethnicity from the provided options.
  5. Indicate which essential skills testing requirement you are waiving by checking one of the options (SAT, ACT, GRE, or PAA).
  6. Complete the required sections for the testing agency from which you are requesting an official score report.
  7. Sign and date the application at the bottom of the form.
  8. Gather your official score report from the testing agency. Ensure it is sent directly to the Connecticut State Department of Education.
  9. Submit the completed form along with the official score report to the Bureau of Educator Standards and Certification at the address provided.

Once your application and score report are submitted, the Bureau of Educator Standards and Certification will review your materials. You will be notified about the status of your waiver application after processing is complete.

Obtain Answers on Connecticut Ed 192

  1. What is the Connecticut Ed 192 form?

    The Connecticut Ed 192 form is an application for the Connecticut Academic Skills Assessment Waiver. This waiver allows individuals to bypass the requirement of taking and passing the Praxis I tests in reading, writing, and mathematics, provided they meet specific criteria through alternative standardized test scores.

  2. Who needs to fill out the Ed 192 form?

    Individuals seeking formal admission to a Connecticut educator preparation program or those applying for educator certification in Connecticut must complete this form if they wish to waive the academic skills testing requirement. This includes prospective educators who have qualifying SAT, ACT, GRE, or PAA scores.

  3. What information is required on the Ed 192 form?

    The form requires personal information such as:

    • Full name
    • Social Security number
    • Contact details (address, phone number, email)
    • Educational background (Bachelor's institution)
    • Gender and birth date
    • Race/Ethnicity (optional)

    Additionally, applicants must indicate which standardized test score they are using to qualify for the waiver.

  4. What types of test scores are accepted for the waiver?

    The Ed 192 form accepts scores from several standardized tests, including:

    • SAT
    • ACT
    • GRE
    • PAA (Prueba de Aptitud Academica)

    Each test has specific score requirements that must be met for the waiver to be granted. Official score reports must be sent directly from the testing agencies to the Connecticut State Department of Education.

  5. How do I submit the Ed 192 form?

    Once you have completed the Ed 192 form and obtained the necessary official test score reports, send them to:

    Bureau of Educator Standards and Certification
    P.O. Box 150471 – Room 243
    Hartford, CT 06115-0471

    Ensure that all documents are completed and submitted together, as the application will not be processed until everything is received.

  6. What happens after I submit the Ed 192 form?

    After submission, the Bureau of Educator Standards and Certification will review your application. If everything is in order and you meet the requirements, you will receive confirmation of your waiver. This process may take some time, so it is advisable to submit your application well in advance of any deadlines.

Common mistakes

Completing the Connecticut Ed 192 form requires attention to detail. One common mistake is failing to provide an official score report. The application will not be processed without it. Candidates must ensure that the score report is sent directly from the testing agency. Reports submitted by the candidates themselves are not acceptable.

Another frequent error involves the personal information section. Applicants often neglect to print all information in blue ink and uppercase letters, as specified. This requirement is crucial for clarity and legibility. Missing or unclear information can delay processing.

Some individuals mistakenly leave out their former last names. If applicable, including this information is essential. It helps the Bureau of Educator Standards and Certification to verify past records and ensures that the application is matched correctly to existing files.

Additionally, applicants sometimes fail to indicate their gender on the form. This detail is necessary for demographic purposes and helps the state maintain accurate records. Omitting this information can lead to unnecessary follow-up requests.

Many candidates overlook the requirement to check the appropriate box for the essential skills testing requirement waived. Failure to select one of the optionsβ€”SAT, ACT, GRE, or PAAβ€”can result in the application being deemed incomplete. This oversight can significantly delay the waiver process.

Inaccurate social security numbers are another common issue. Providing the wrong number can lead to complications in processing the application. Applicants should double-check this information for accuracy before submission.

Moreover, some applicants forget to sign and date the form. The signature is a critical part of the application, indicating that the information provided is accurate and complete. Without a signature, the application may be returned or rejected.

Finally, candidates often neglect to review the application directions on page 6. Ignoring these instructions can lead to multiple errors and omissions, ultimately affecting the application’s acceptance. Careful review of all instructions is essential for a successful submission.

Documents used along the form

The Connecticut Ed 192 form is an application for the Connecticut Academic Skills Assessment Waiver. This waiver allows prospective educators to bypass the requirement of taking and passing the academic skills tests, provided they meet certain criteria. Several other forms and documents are commonly used in conjunction with this application to facilitate the process.

  • Official Score Reports: These documents provide verified results from standardized tests such as the SAT, ACT, GRE, or PAA. They must be sent directly from the testing agencies to the Connecticut State Department of Education.
  • PAA Score Request Form: This form is used to request the forwarding of PAA scores from the College Board in Puerto Rico to the Connecticut State Department of Education. It is necessary for candidates who wish to use PAA scores as part of their waiver application.
  • Transcript of Academic Records: An official transcript from the candidate's college or university may be required to verify educational qualifications. It must include relevant coursework and grades.
  • Proof of Identity: Documentation such as a driver's license or passport may be needed to confirm the identity of the applicant. This helps ensure the integrity of the application process.
  • Certification of Employment: For candidates currently employed in educational settings, a certification from their employer may be required. This document verifies their position and experience in the education field.
  • Application for Educator Certification: This form is often required for those seeking certification in Connecticut. It outlines the applicant's qualifications and readiness to enter the teaching profession.
  • Background Check Authorization: Candidates may need to provide consent for a background check. This is a standard procedure to ensure the safety and well-being of students.
  • Personal Statement: Some applicants may be asked to submit a personal statement detailing their teaching philosophy, experiences, and reasons for seeking a waiver. This document provides insight into the candidate's motivations and qualifications.
  • Residency Verification: Proof of residency in Connecticut may be necessary for applicants. This can include utility bills or lease agreements showing the applicant's current address.

These documents and forms play a critical role in the application process for the Connecticut Academic Skills Assessment Waiver. Ensuring that all necessary paperwork is completed and submitted accurately can facilitate a smoother review process by the Bureau of Educator Standards and Certification.

Similar forms

The Connecticut Ed 192 form is primarily an application for waiving the Connecticut Academic Skills Assessment requirement. Similar documents serve comparable purposes in the context of educational assessments and certifications. Here are six documents that share similarities with the Ed 192 form:

  • Praxis I Registration Form: This form is used by candidates to register for the Praxis I tests, which assess basic academic skills in reading, writing, and mathematics, similar to the skills assessed by the Ed 192 form.
  • SAT Score Report Request Form: This document allows individuals to request their SAT scores, which can be used to demonstrate academic proficiency, just like the scores submitted with the Ed 192 application.
  • ACT Score Report Request Form: Similar to the SAT request form, this document is used to obtain ACT scores. These scores can also qualify candidates for a waiver under the Ed 192 form.
  • GRE Score Report Request Form: This form enables candidates to request their GRE scores, which may fulfill the academic skills requirement, paralleling the purpose of the Ed 192 form.
  • TOEFL Score Report Request Form: For non-native English speakers, this document is used to request TOEFL scores, which can demonstrate English proficiency, akin to the requirements outlined in the Ed 192 form.
  • PAA Score Request Form: This form is specific to the Prueba de Aptitud Academica (PAA) and allows candidates to request their scores, which can be used as a waiver option, similar to the provisions in the Ed 192 application.

Dos and Don'ts

When filling out the Connecticut Ed 192 form, there are several important guidelines to keep in mind. Adhering to these recommendations can help ensure your application is processed smoothly.

  • Print clearly: Use blue ink and write all information in uppercase letters to enhance legibility.
  • Provide accurate personal information: Double-check that your name, social security number, and contact details are correct.
  • Submit official score reports: Ensure that all test scores are sent directly from the testing agency, as scores sent by you will not be accepted.
  • Complete all required sections: Fill out every part of the application, including personal information and the waiver request.
  • Do not leave blanks: If a section does not apply to you, indicate this clearly instead of leaving it empty.
  • Avoid using pencil: Always use blue ink, as pencil entries may not be processed correctly.
  • Do not forget to sign: Ensure your application is signed and dated before submission to avoid delays.
  • Never submit incomplete documents: Review your application thoroughly to confirm that all necessary documents are included.

Misconceptions

Understanding the Connecticut ED 192 form can be challenging, and several misconceptions often arise. Here are eight common misunderstandings about the Connecticut Academic Skills Assessment Waiver Application:

  • Misconception 1: The application can be submitted without official test scores.
  • In reality, the application will not be processed until both the completed form and an official score report are received. Scores sent by candidates themselves are not accepted.

  • Misconception 2: You can use any test score from any date.
  • This is not true. Only specific scores from recognized tests like the SAT, ACT, GRE, or PAA that meet the minimum standards are valid. Additionally, scores must be sent directly from the testing agency.

  • Misconception 3: The waiver is available to everyone regardless of their educational background.
  • The waiver is only available to individuals who meet specific criteria, such as those seeking formal admission to an educator preparation program in Connecticut or those seeking certification.

  • Misconception 4: You can submit a photocopy of your test scores.
  • This is incorrect. The Connecticut State Department of Education requires official score reports sent directly from the testing agencies. Photocopies or forwarded scores from applicants will not be accepted.

  • Misconception 5: There is no deadline for submitting the application.
  • While the document does not specify a deadline, it is crucial to submit the application and scores as early as possible to ensure timely processing. Delays could affect your ability to meet program requirements.

  • Misconception 6: You can choose any test to waive the requirement.
  • Applicants must select from specific tests listed in the application. Each test has its own minimum score requirements that must be met to qualify for the waiver.

  • Misconception 7: The application can be filled out in any color of ink.
  • To ensure clarity and legibility, all information must be printed in blue ink and in uppercase letters as specified in the application instructions.

  • Misconception 8: The waiver means you do not need to take any tests at all.
  • The waiver allows you to bypass the Praxis I tests, but it does not exempt you from meeting other educational or certification requirements. Applicants must still fulfill all other criteria set by the state.

Key takeaways

Filling out and utilizing the Connecticut Ed 192 form requires careful attention to detail. Here are key takeaways to consider:

  • Complete the Form Accurately: Ensure all personal information is filled out using blue ink and uppercase letters.
  • Official Score Reports Required: The application will not be processed without official score reports from SAT, ACT, GRE, or PAA.
  • Waiver Eligibility: Understand that the waiver is an alternative to taking the Praxis I tests, which are mandatory for prospective educators in Connecticut.
  • Submission Timeline: Submit the completed form and score reports promptly to avoid delays in processing.
  • Multiple Test Attempts: If you have taken the SAT, ACT, or GRE multiple times, your highest scores will be considered for the waiver.
  • Contact Information: Familiarize yourself with the contact details of testing agencies for obtaining score reports to ensure timely submission.
  • Follow Up: After submission, consider following up with the Bureau of Educator Standards and Certification to confirm receipt of your application and scores.