Certified Test Administration Site Application Form

To apply for the Certified Test Administration Site (CTAS) program, please complete this online form.
If you are responding to an e-mail or other correspondence from ETS, please include your Reference
ID to expedite the application process.

IN ADDITION TO COMPLETING THIS APPLICATION, please submit at least 2 digital photos of

each testing lab and a digital photo of the exterior of the testing facility (outside of the
building). These should be sent to CTAS@ets.org. Be sure to include the institution name in
the email subject line EXACTLY as it is written in the section on Organization Information.

Note that fields marked with an * are required.

Individual Profile

Reference ID
(if provided by ETS)
Prefix Mrs.
(Mr., Mrs., Ms., etc.)
First Name:
*
Last Name: Coy
*
Suffix:

Job Title: Coordinator

*
Department: English
*
Contact Information

E-mail Address:
*
Phone number with area code: 55-19-3754-8500
*
Fax Number with area code: 55-19-3754-8500
*
Job Responsibilities

*Please indicate your role in deciding whether your organization may

participate in an ETS Certified Education Partner program.

I am the decision maker

I am one of the decision makers

I make recommendations to the decision maker(s)

I am not involved in the decision making

If you are not the sole decision maker, who else would be involved in
determining your participation?

Name:
E-mail Address:

Organization Information

Test Site Reporting Address:

P.O. Boxes are not acceptable.
Country Brazil
*
Institution Name: FACAMP
*
Address 1: Estrada Municipal UNICAMP-Telebrás Km 1
*
Address 2: Cidade Universitária

Address 3:
City: Campinas
*
State/Province: São Paulo

Zip/Postal Code: 13083-970

*
Organization Type

*Organization Type
University/College

Test Site Shipping Address:

*Is Shipping Address the same as Reporting Address?

Yes

No --> Please complete the section below

Country
First Name of Person to ship to:

Last Name of Person to ship to:

Institution Name:

Shipping Address 1:
Shipping Address 2:

Shipping Address 3:
City:

State/Province:
Zip/Postal Code:
Background Information
*What are the advantages to ETS test takers to have a test center at your
location?

Many of our students are requesting scholarships for post-graduate studies and one of the
requirements is the TOEFL test. It would make it easier for our students, as well as for the
students of neighboring universities if the testing center were close by.

*Please provide references such as educational accreditation status by a

government organization, official educational accreditation agency or
membership association.

Ministério da Educação - Ciência sem Fron

*How many years has your organization been in operation?

11
years

*How many years has your organization been at your current location?

11
years

If available, please provide the URL for your institution/organization.

Available Internet-Based Tests

Which Internet-Based Test(s) are you interested in administering at your
site? (Check all that apply.)

Georgia Assessments for the Certification of Educators (FOR GEORGIA ONLY)

PRAXIS (US ONLY)

Texas Examination of Educator Standards (FOR TEXAS ONLY)

TOEFL

Operational Profile
To conduct Internet-based tests, you will need to provide a secure room for
approximately a 6-hour block of time.

TOEFL iBT tests are typically administered on Fridays, Saturdays and Sundays.
TExES, PRAXIS and GACE tests are administered Monday through Saturday.

*How many secure rooms with computers do you have available for ETS
test administrations? (Up to 3)
3

How many computers are available in each lab?

Lab 1: 30
*
Lab 2:
Lab 3:

Start Date
On what date could you begin participating in ETS test administrations?

Month:
January

Day:

14

Year:

2013

If you encounter difficulty submitting this form, please print and fax it to
609-406-5360. Please be sure to include the complete answer to each
question under the heading "Background Information".

Submit Form

1279
Certified Test Administration Site Application
Form

Thank you for your interest in becoming a Certified Test Administration

Site. This is to confirm receipt of your application.
Your application will be reviewed to determine if there is a need for new
sites in your area. We appreciate your patience during this review period,
and we will provide a response as soon as the assessment is completed.

Thank you for your patience.

All inquiries should be submitted to

CTAS@ets.org.