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TOEFL iBT RESCORING REQUEST FORM
®
Check the appropriate box, complete the form, and follow the submission instructions below. I request that the following be reviewed through the rescore process for the test date indicated below: Speaking and Writing (US$160) Test Date: Name: Address (include ZIP or postal code):
Month Day
Speaking (US$80)
Year
Writing (US$80) Registration Number: Date of Birth:
Month
Day
Year
Check this box if your mailing address has changed since the test date indicated above. Print your new address below. Address (include ZIP or postal code):
Check if paying by Credit/Debit Card Number
American Express®
Discover ®
JCB®
MasterCard®
VISA®
Expiration Date —
Copyright © 2012 by Educational Testing Service, Princeton, NJ.
Month
Year
Complete the form and send it with the required fee to: TOEFL® Services ETS PO Box 6151 Princeton, NJ 08541-6151 USA
SUBMITTING THE TOEFL iBT RESCORING REQUEST FORM
CUT HERE #
NOTE: Only one rescoring request per test administration can be submitted. Checks must be made payable to ETS-TOEFL iBT. NOTE: YOUR TEST CANNOT BE RESCORED. IF YOUR SCORES HAVE ALREADY BEEN SENTn No. 131414468 RT) H / QST (Reg.S 1087967545) toC ge ( T S and R T GNo. d d a aa da ,n total TO AN INSTITUTION OR AGENCY. By sending your check, you authorize ETS to convert the check into an electronic funds transfer. Please be aware that your bank account may be debited the same day we receive your payment and you will not receive a canceled check. If you are paying by credit/debit card, this form may be faxed. Faxed requests will not be processed unless complete credit/debit card information is provided. The fax number is 1-610-290-8972. The results of the rescoring process will be available approximately three weeks after receipt of your Rescoring Request Form and payment. NOTE: All forms will be processed upon receipt, and a charge will be made to your credit/debit card. If you think your
®
Check the appropriate box, complete the form, and follow the submission instructions below. I request that the following be reviewed through the rescore process for the test date indicated below: Speaking and Writing (US$160) Test Date: Name: Address (include ZIP or postal code):
Month Day
Speaking (US$80)
Year
Writing (US$80) Registration Number: Date of Birth:
Month
Day
Year
Check this box if your mailing address has changed since the test date indicated above. Print your new address below. Address (include ZIP or postal code):
Check if paying by Credit/Debit Card Number
American Express®
Discover ®
JCB®
MasterCard®
VISA®
Expiration Date —
Copyright © 2012 by Educational Testing Service, Princeton, NJ.
Month
Year
Complete the form and send it with the required fee to: TOEFL® Services ETS PO Box 6151 Princeton, NJ 08541-6151 USA
SUBMITTING THE TOEFL iBT RESCORING REQUEST FORM
CUT HERE #
NOTE: Only one rescoring request per test administration can be submitted. Checks must be made payable to ETS-TOEFL iBT. NOTE: YOUR TEST CANNOT BE RESCORED. IF YOUR SCORES HAVE ALREADY BEEN SENTn No. 131414468 RT) H / QST (Reg.S 1087967545) toC ge ( T S and R T GNo. d d a aa da ,n total TO AN INSTITUTION OR AGENCY. By sending your check, you authorize ETS to convert the check into an electronic funds transfer. Please be aware that your bank account may be debited the same day we receive your payment and you will not receive a canceled check. If you are paying by credit/debit card, this form may be faxed. Faxed requests will not be processed unless complete credit/debit card information is provided. The fax number is 1-610-290-8972. The results of the rescoring process will be available approximately three weeks after receipt of your Rescoring Request Form and payment. NOTE: All forms will be processed upon receipt, and a charge will be made to your credit/debit card. If you think your