154163-035843 • UNLWEB823
Praxis
®
ADDITIONAL SCORE REPORT REQUEST
Use this form to request that your Praxis
®
scores be sent to a designated score recipient or to yourself. Your report will include your highest score for each
test taken over the last 10 years. Complete and mail this form with a remittance of $50 for each report requested. ETS will honor a telephone or faxed
request to send your scores to a recipient. Additional score reports are issued within five calendar days for phone requests and seven business days for
U.S. mail or fax requests. If you request that your score report be sent to a designated score recipient, you will automatically receive a score report through
your online Praxis account confirming that your scores were sent as requested. Scores for a specific test will be sent to a recipient only if that recipient is
eligible to receive those scores.
You may not use this form to delete or substitute score recipients previously selected during registration.
PLEASE PRINT ALL INFORMATION BELOW.
CANDIDATE ID NUMBER
(if available)
NAME: Print your last name, first name, and middle initial exactly as you did when you last tested.
Last Name – first 15 letters
First Name – first 10 letters M.I.
NAME AT TIME OF EARLIER TEST, IF DIFFERENT
PRESENT ADDRESS: Number and Street (include apartment number)
City
–
State ZIP Code (U.S. only)
Country Code
(outside U.S. & P.R. only)
Check here if this
is a new address.
DATE OF BIRTH
Month Day Year
DAYTIME TELEPHONE NUMBER
– –
LATEST TEST DATE
(approximately)
Month Day Year
Please check box, if applicable:
I recently tested and I want my request held until scores for that
I am requesting only a test taker score report (I do not want my
scores reported to any score recipients). Fee for test taker score
report is $50.
NOTE: Public and county schools are generally not score
recipients. Please check the Recipient Code List
on the Praxis website before entering information below.
FEES (See the website for more information.)
Number of reports
×
$50 = $
In Canada, add GST/HST and QST to total remittance.
GST/HST Reg. #131414468 RT
........................................ $
QST Reg. #1087967545 .................................................. $
Add Value Added or similar taxes where applicable.* ........ $
AMOUNT DUE ............................................................... $
*See “Fees” section of the Praxis website (https://www.ets.org/praxis/
about/fees/) for information about taxes.
Orders received without payment or with incorrect payment
Payment enclosed American Express
®
Visa
®
Discover
®
MasterCard
®
JCB
®
Credit/Debit Card Number Expiration Date
Cardholder’s Signature
PLEASE PRINT SCORE RECIPIENT INFORMATION BELOW.
(Use the Attending Institution/Recipient Code List on the Praxis website.)
CODE SCORE RECIPIENT LOCATION
R
R
R
R
I authorize Educational Testing Service (ETS) to release my scores, under the conditions set forth in the Praxis
®
Information
Bulletin, to the score recipients designated on this form.
Signature
Date
Copyright © 2023 by ETS. All rights reserved. ETS, the ETS logo, and PRAXIS are registered trademarks of ETS in the United States and other countries.
Other products, services, and brand names mentioned herein may be trademarks of their respective owners.
