PPAT® assessment fee reduction request form 2022–2023

PPAT® Assessment Fee Reduction Request Form 2022–2023 Copyright © 2022 by Educational Testing Service All rights reserved ETS, the ETS logo, and PPAT are registered trademarks of Educational Testing S[.]

Copyright © 2022 by Educational Testing Service All rights reserved

ETS, the ETS logo, and PPAT are registered trademarks of Educational Testing Service (ETS) in the United States and other countries

PPAT® Assessment Fee Reduction Request Form 2022–2023

Updated 6/2022

A limited number of test fee reductions are available for undergraduate or graduate students who meet all eligibility criteria

See the ETS® Performance Assessments informational website for eligibility and application information

If you are approved for a fee reduction, the test fee for the PPAT® assessment may be reduced by $100 The reduction will be

provided in the form of a voucher to be used at registration Registration payments made with prepaid vouchers are not eligible for this fee reduction The $100 fee reduction voucher cannot be combined with another voucher when purchasing the registration

Submission window you are applying for:  Fall 2022  Spring 2023

Please print all information below

Date: _ ETS Online Account ID: _

Applicant’s Name (print your name as it appears in your online account)

First Name: M.I.: Last Name: Street Address: _ City: _ State or Province: _ Zip or Postal Code: _ Email Address: Daytime Phone Number: Evening Phone Number:

Fee Waiver Request Personal Information (Information provided on this form is considered confidential)

1 Current Education Level (Select one of the following)

 Undergraduate  Earned Bachelor’s Degree  Earned Master’s Degree  Earned Doctoral Degree

You are ineligible if you have a Master’s degree or a Doctoral Degree

2 Name of Institution or Agency Requiring Your Scores

(must be an authorized score recipient)

3 Name of Institution You Currently Attend _ This completed form, Enrollment Verification Certificate, and FAFSA Student Aid Report (SAR) must be received by the deadline Late or incomplete requests will not be processed Note that fee reduction funds are limited Funds may be

exhausted prior to the deadline

Submission Window Deadline for Request

Send completed form and required paperwork: