COSMETOLOGY, NAIL TECHNICIAN, ESTHETICIAN, ELECTROLOGIST AND BARBER LICENSING EXAMINATIONS CANDIDATE INFORMATION BULLETIN

Similar documents
NORTH DAKOTA STATE BOARD OF COSMETOLOGY COSMETOLOGY WRITTEN EXAMINATION INFORMATION

DISTRICT OF COLUMBIA Department of Consumer and Regulatory Affairs Professional Licensing Examination Washington, DC Land Surveyor Examination

CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION

PROFESSIONAL LICENSING BOARDS DIVISION GEORGIA AUCTIONEER LICENSURE EXAMINATION CANDIDATE INFORMATION BULLETIN

STATE OF UTAH DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING CERTIFIED PUBLIC ACCOUNTANT (CPA) EXAMINATION CANDIDATE INFORMATION BULLETIN

ACTION CERTIFIED PERSONAL TRAINER WRITTEN EXAMINATION INFORMATION

PROFESSIONAL LICENSING BOARDS DIVISION GEORGIA FUNERAL SERVICE LAWS AND RULES EXAMINATION CANDIDATE INFORMATION BULLETIN

PROFESSIONAL LICENSING BOARDS DIVISION GEORGIA PRIVATE AGENCY LICENSURE EXAMINATION CANDIDATE INFORMATION BULLETIN

IOWA DEPARTMENT OF PUBLIC SAFETY ELECTRICAL EXAMINING BOARD

JURISPRUDENCE AND DENTAL ASSISTANT STATE LICENSING EXAMINATIONS CANDIDATE INFORMATION BULLETIN

PROFESSIONAL LICENSING BOARDS DIVISION GEORGIA FUNERAL SERVICE LAWS AND RULES EXAMINATION CANDIDATE INFORMATION BULLETIN

PROFESSIONAL LICENSING BOARDS DIVISION GEORGIA PRIVATE AGENCY LICENSURE EXAMINATION CANDIDATE INFORMATION BULLETIN

TENNESSEE COSMETOLOGY BOARD

STATE OF SOUTH CAROLINA REGISTERED BARBER, BARBER INSTRUCTOR AND MASTER HAIR CARE EXAMINATIONS

LICENSED MENTAL HEALTH TECHNICIAN EXAM PREPARATION GUIDE

COMMONWEALTH OF PENNSYLVANIA

Massachusetts Board of Certification of Operators of Wastewater Treatment Facilities Computerized Certification Examination Information

ASSISTED LIVING ADMINISTRATOR AND MEDICATION AIDE CERTIFICATION EXAMINATIONS CANDIDATE INFORMATION BULLETIN

COMMONWEALTH of VIRGINIA

Candidate Information Booklet. Dental Laws & Rules Computer Based Testing (CBT) Examination

2006 NCLEX Examination Candidate Bulletin

CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS

CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS

WI Procedures for Applying for Examination (Work Experience Instructor Candidate)

South Carolina BOARD OF COSMETOLOGY. September Instructor

MARYLAND DEPARTMENT OF LABOR, LICENSING AND REGULATION BARBER, MASTER BARBER, AND BARBER STYLIST CANDIDATE INFORMATION BULLETIN

SPONSOR/CANDIDATE HANDBOOK Registered Nursing Assistant

OPTOMETRY EXAMINING BOARD OF CANADA

MULTIPLE SCLEROSIS NURSING INTERNATIONAL CERTIFICATION EXAMINATION

Commonwealth of Virginia Lead Abatement

Natural Hair Stylist

Preparing for the NCLEX. Carol Moreland, MSN, APRN, CNS Education Specialist, KSBN

DIVISION OF WORKERS COMPENSATION (TEXAS DEPARTMENT OF INSURANCE)

2016 JLPT Test Site Information Columbus, OH

California Board of Vocational Nursing and Psychiatric Technicians Written Licensure Examination

Wyoming Certified Nursing Assistant Examination Application

TOEIC Listening & Reading Secure Program guidelines

Rochester Community & Technical College Nursing Assistant and/or Home Health Aide Testing

Sunday, May 20, 2018

POLICE OFFICER / DEPUTY SHERIFF (POLICE) Date Published: 09/13/2017 Exam Date: 12/02/2017

CALIFORNIA CERTIFIED MEDICAL ASSISTANT EXAMINATION APPLICATION

Candidate Information Booklet

If applying for Testing Accommodations under the Americans with Disabilities Act (ADA):

COMMUNITY, COUNSELING & CORRECTIONAL SERVICES, INC. Gallatin County Re-Entry Program SPONSOR FORM

Summer Bridge 2015 Arrival Packet

Missouri. BOARD OF COSMETOLOGY and BARBER EXAMINERS. April Hairdresser

PSI licensure:certification 3210 E Tropicana Las Vegas, NV

Application for Admission Nurse Aide Training Program

A Guide to Your Surgery

Checklist for Entry-Level Midwife, Form 111 Phase 2, Assistant Under Supervision, page 1 of 2

If applying for Testing Accommodations under the Americans with Disabilities Act (ADA):

Certified Nurse Manager and Leader

Natural Hair Stylist

SPEX INFORMATION BULLETIN

CALVERT COUNTY DIVISION OF PARKS AND RECREATION APPLICATION FOR USAGE OF COMMUNITY CENTER FACILITIES

2015 JLPT Test Site Information San Francisco, CA

Exam Guide. MSNCB National Office. Mailing Address MSNCB PO Box 56 Pitman, NJ Delivery Service MSNCB 200 East Holly Avenue Sewell, NJ 08080

Ordering Secure Exams

D.L. Roope Administrations Inc. Candidate Handbook WISCONSIN MANICURIST (NIC NAIL TECHNICIAN)

Research Access to the Washingtoniana Collection at the Albert H. Small Center for National Capital Area Studies Reading Room

Rules for Visitation 1. The Tulsa County Sheriff's Office may terminate a visit at any time. 2. The Tulsa County Sheriff's Office reserves the right

If applying for Testing Accommodations under the Americans with Disabilities Act (ADA):

2014 BAY STATE GAMES MARATHON TEAM

Laramie County Sheriff s Department. Volunteer Handbook

TEXAS DEPARTMENT OF LICENSING AND REGULATION

If applying for Testing Accommodations under the Americans with Disabilities Act (ADA):

Summer Recreation/Adult Education Program

CERTIFICATION EXAMINATION FOR LIFETIME NURSE CARE PLANNERS

Professional Credential Services, Inc.

12 King Philip Rd. Sudbury, MA (585)

Arkansas Certified Nursing Assistant Examination Application

Documents for Accepted Students

KEAN UNIVERSITY Student Party and Special Events Policy and Procedures

P r o f e s s i o n a l C r e d e n t i a l S e r v i c e s, I n c. Page 1

Italian Visa Requirements

JONES COUNTY JUNIOR COLLEGE ASSOCIATE DEGREE NURSING PROGRAM 900 S. Court Street - Ellisville, MS 39437

Non-Emergency Medical Transportation

NNevada State Board of

AMERICAN BOARD OF CHIROPRACTIC ACUPUNCTURE (ABCA) Candidate Handbook

NBSTSA CSFA Pre-Authorization for Clinical Experience Certified Surgical First Assistant (CSFA) Examination (For CSTs with Currency)

Frequently Asked Questions for. Test of Essential Academic Skills (TEAS ) UNF School of Nursing

Syria Archaeological Field School Summer 2010 Acceptance Instructions

ORAL EXAMINATION CANDIDATE GUIDELINES AMERICAN BOARD OF OTOLARYNGOLOGY

Volunteer Firefighter Recruit Requirements and Application Procedures

For tuition prices please contact our school.

Grace Health Career Center, LLC. Certified Nurse Aide Application & Registration Information

FREQUENTLY ASKED QUESTIONS

Commonwealth of Virginia BOARD FOR BARBERS AND COSMETOLOGY. February Candidate Information Bulletin

Frozen Ropes Summer Program Information Packet

January 2018 ESCANABA SCHEDULE

Pennsylvania State Board of Barber Examiners

Professional Credential Services, Inc.

Rotation Information For Visiting Medical Students

REGISTRATION PLEASE FILL OUT THE ATTACHED REGISTRATION FORM

FH GRAD NEWS. Save the Date. Grads of 2016: Leaving the Nest. Commencement. Graduation Banquet. Dry Grad. In This Issue

JONES COUNTY JUNIOR COLLEGE

D.L. Roope Administrations Inc. Candidate Handbook WASHINGTON COSMETOLOGIST

Junior Baseball Spring 2017 Ages 8 & 9

***DO NOT RETURN THIS SHEET WITH APPLICATION*** Mayfield Heights Civil Service Commission Firefighter/Paramedic Exam Application Page 1

Closed Captioning Service Closed Captioning will be available on the North Video Board for all announcements.

Transcription:

PSI Services LLC 3210 E Tropicana Las Vegas, NV 89121 Phone: (800) 733-9267 Fax: (702) 932-2666 E-mail: examschedule@psionline.com www.psiexams.com COSMETOLOGY, NAIL TECHNICIAN, ESTHETICIAN, ELECTROLOGIST AND BARBER LICENSING EXAMINATIONS CANDIDATE INFORMATION BULLETIN TABLE OF CONTENTS Examinations by PSI... 2 Examination Payment and Scheduling... 2 Online Scheduling... 2 Telephone Scheduling... 2 Canceling and Rescheduling an Examination... 2 Missed Appointment or Late Cancellation... 2 Exam Accommodations... 2 Examination Site Closing for an Emergency... 2 Examination Site Locations... 2 Reporting to the Examination Site... 3 Required Identification... 3 Security Procedures... 4 Taking the Examination... 4 Identification Screen... 4 Tutorial... 4 Score Reporting... 5 Duplicate Score Report... 5 Experimental Items... 5 NIC Examination Content Outline... 5 Exam Accommodations Request Form... 6 Please refer to www.psiexams.com to check for the most updated information. Copyright 2015 by PSI Services LLC Revised 12/1/2015

ABOUT PSI This Candidate Information Bulletin provides you with information about the examination process for a cosmetologist, nail technician, esthetician, electrologist and barber stylist license in the State of Rhode Island. The Rhode Island Department of Health (RIDOH) has contracted with PSI to conduct examinations. For more information on licensure please contact RIDOH at (401) 222-5960 or visit the Web site at http://www.health.ri.gov/contact/. EXAMINATION PAYING AND SCHEDULING It is your responsibility to contact PSI to pay and schedule for the examination. If you fail, you may take the examination on an unlimited basis. A separate fee is required for each examination attempt. Examination Examination Fee Written Examination $75 NOTE: EXAMINATION FEES ARE NOT REFUNDABLE OR TRANSFERABLE. THE EXAMINATION FEE IS VALID FOR ONE YEAR FROM THE DATE OF PAYMENT. ONLINE (www.psiexams.com) For the fastest and most convenient examination scheduling process, register for your examinations online by accessing PSI s registration Web site at www.psiexams.com. Internet registration is available 24 hours a day. Log onto PSI s website and create an account. You will be asked to put in your email address and the spelling of your name exactly as it is shown on your identification that will be presented at the examination site. You will be asked to select the examination. You will then enter your personal and contact information. You will then be ready to pay and schedule for the examination. Enter your zip code and a list of the examination sites closest to you will appear. If you prefer to test at a location outside the state of Rhode Island, a drop down menu allows you to select a different state. Once you select the desired examination site, available dates will appear. TELEPHONE Call (800) 733-9267, PSI registrars are available to receive payment and to schedule your appointment for the examination. Please call Monday through Friday between 7:30 am and 10:00 pm, and Saturday-Sunday between 9:00 am and 5:30 pm, Eastern Time. To register by phone, you need a valid credit card (VISA, MasterCard, American Express or Discover.) RESCHEDULING/CANCELING AN EXAMINATION APPOINTMENT You may cancel and reschedule an examination appointment without forfeiting your fee if your cancellation notice is received 2 days before the scheduled examination date. For example, for a Monday appointment, the cancellation notice would need to be received on the previous Saturday. You may reschedule online at www.psiexams.com or call PSI at (800) 733-9267. Note: A voice mail message is not an acceptable form of cancellation. Please use the PSI Website or call PSI and speak directly to a Customer Service Representative. MISSED APPOINTMENT OR LATE CANCELLATION You will forfeit your examination fee if you: Do not cancel your appointment at least 2 days before the scheduled examination date; Do not appear for your examination appointment; Arrive after examination start time; or Do not present proper identification when you arrive for the examination. EXAM ACCOMMODATIONS PSI examination centers are equipped to provide access in accordance with the Americans with Disabilities Act (ADA) of 1990, and exam accommodations will be made in meeting a candidate's needs. An applicant with a disability or an applicant who would otherwise have difficulty taking the examination must complete the Exam Accommodations Request Form at the end of this Candidate Information Bulletin and fax it to PSI (702) 932-2666 or Email it to PSI at examaccommodations@psionline.com. This form also includes out-of-state testing requests. EXAMINATION TEST CENTER CLOSING FOR AN EMERGENCY If severe weather or another emergency forces the closure of an examination center on a scheduled examination date, your examination will be rescheduled. PSI personnel will attempt to contact you in this situation. However, you may check the status of your examination appointment by calling (800) 733-9267 or viewing the website at www.psiexam.com. Every effort will be made to reschedule your examination at a convenient time as soon as possible. You will not be penalized. Your exam will be rescheduled at no additional charge to you. EXAMINATION SITE LOCATIONS The examinations are administered at the examination centers listed below: Cranston Garden City Center 100 Midway Road, Suite 13 Cranston, RI 02920 From MA, I-195 W becomes I-95 S. Merge onto RI-37 W toward Cranston. Take the Pontiac Ave exit and turn right. Turn left onto Sockanosset Cross Road, then turn right onto Midway Road. The building is on the left side, and has a Liberty Mutual sign and a big green awning. At the building, go all the way down the hall and turn left to PSI Suite 13 on the right. WWW.PSIEXAMS.COM 2

West Hartford 45 South Main Street, Suite 209 West Hartford, CT 06107 From I-84, exit 41, S. Main St. and proceed north approximately 2 miles. 45 South Main will appear on the left, directly across the street from the Town Hall, before you cross Farmington Avenue. The attendant will park your car at no charge. Take the elevator to the second floor to Suite 209. Milford 500 BIC Drive, Suite 101 Milford, CT 06461 From Highway I-95 exit 35. Go toward BIC Drive. Go.5 miles to 500 BIC Drive which is at Gate 1 of the former BIC complex. Go to the rear of the lot and park. Walk down the hill in front of the building and enter the front door. Signs will direct you to Suite 101 (PSI). Auburn 48 Sword St, Unit 204 Auburn, MA 01501 From Southbridge St/MA-12, turn left onto Sword St. Boston Inner Tech Park, 56 Roland St., Suite 211 Boston, MA 02129 From North: Take I-93 South. Exit 28 Boston/Sullivan Sq./Charlestown. Merge into Mystic Ave. Take I-93S Ramp to Boston/Sullivan Sq./Charlestown (take ramp do not get on highway). Make slight left turn on to Maffa Way. Make slight right turn on to Cambridge Street. At first traffic light, make left on to Carter Street There is a sign for Inner Tech Park. Right on to Roland Street. Ene at 56 Roland Street (Building on left, parking lot on right). Enter through North lobby. Fall River 218 South Main St, Suite 105 Fall River, MA 02721 From the North take Rte. 24S to 79S. Take Route 138S Exit. Bear right off exit. Go left at first traffic light. Take left at the second traffic light (top of hill) onto So Main St. 218 is 2 blocks down on the right. Parking: Go past 218 SO Main to 2nd light. Take right. Take another right at next traffic light. Third St parking Garage is on your right. Lawrence 1 Ballard Way, Suite 104 Lawrence, MA 01843 From the North take Rte. I-93 S to Exit 45, River Rd./S. Lawrence. Take the ramp toward River Rd./S Lawrence. Take a slight right onto River Rd. River Road becomes Andover St. Turn right onto Ballard Rd. Turn left onto Ballard Way. There is a sign for N-Tek, Inc. on the right. Turn left into the parking lot marked "Still Water Place, Ballard Way". PSI is located in the first suite on the left beneath Yellow Book and the Asian Center office. From the South take I-93 N to Exit 45, River Rd./ S. Lawrence. Take the River Rd. ramp toward River Rd./ S. Lawrence. Turn left on River Rd. River Rd. becomes Andover St. Turn right onto Ballard Rd. Turn left onto Ballard Way. There is a sign for N-Tek, Inc. on the right. Turn left into the parking lot marked "Stillwater Place, Ballard Way". Springfield 1111 Elm Street, Suite 32A West Springfield, MA 01089 Going East on Mass Pike (Rt. 90). Take Exit 4 - West Springfield/Holyoke. Turn right on West Springfield/Rt. 5 South. Continue on Rt. 5 approximately two miles. Turn right on Elm St. - immediately after Showcase Cinemas. Office is approximately 1/4 mile on the right. Going West on Mass Pike (Rt. 90). Springfield/Holyoke. Follow as above. Take Exit 4 - West REPORTING TO THE EXAMINATION SITE On the day of the examination, you should arrive at least 30 minutes prior to your scheduled appointment time. This allows time for sign-in and identification verification and provides time for you to familiarize yourself with the examination process. If you arrive late, you will not be admitted to the examination site and you will forfeit your examination registration fee. REQUIRED IDENTIFICATION Candidates must register for the exam with their LEGAL first and last name as it appears on their government issued identification. All required identification below must match the first and last name under which the candidate is registered. Candidates are required to bring one (1) form of valid (non-expired) signature bearing identification to the test site. If the candidate fails to bring proper identification or the candidate names do not match, the candidate will not be allowed to test and their examination fee will not be refunded. PRIMARY IDENTIFICATION (with photo) Choose One State issued driver s license State issued identification card Government issued passport (including all countries) Government issued military identification card (including all countries) Government issued Alien Registration Card (including all countries) Current high school ID with photo, or a notarized photograph bearing the candidate s signature. NOTE: ID must contain candidate s photo, signature, be valid and unexpired. If you cannot provide the required identification, you must call (800) 733-9267 at least 3 weeks prior to your scheduled appointment to arrange a way to meet this security requirement. Failure to provide all of the required identification at the time of the examination without notifying PSI is considered a missed appointment, and you will not be able to take the examination at that time. WWW.PSIEXAMS.COM 3

SECURITY PROCEDURES The following security procedures will apply during the examination: Calculators, scratch paper, and pencils. are not allowed. Candidates may take only approved items into the examination room. All personal belongings of candidates, with the exception of close-fitting jackets or sweatshirts, should be placed in the secure storage provided at each site prior to entering the examination room. Personal belongings include, but are not limited to, the following items: - Electronic devices of any type, including cellular / mobile phones, recording devices, electronic watches, cameras, pagers, laptop computers, tablet computers (e.g., ipads), music players (e.g., ipods), smart watches, radios, or electronic games. - Bulky or loose clothing or coats that could be used to conceal recording devices or notes, including coats, shawls, hooded clothing, heavy jackets, or overcoats. - Hats or headgear not worn for religious reasons or as religious apparel, including hats, baseball caps, or visors. - Other personal items, including purses, notebooks, reference or reading material, briefcases, backpacks, wallets, pens, pencils, other writing devices, food, drinks, and good luck items. Person(s) accompanying an examination candidate may not wait in the examination center, inside the building or on the building's property. This applies to guests of any nature, including drivers, children, friends, family, colleagues or instructors. No smoking, eating, or drinking is allowed in the examination center. During the check in process, all candidates will be asked if they possess any prohibited items. Candidates may also be asked to empty their pockets and turn them out for the proctor to ensure they are empty. The proctor may also ask candidates to lift up the ends of their sleeves and the bottoms of their pant legs to ensure that notes or recording devices are not being hidden there. Proctors will also carefully inspect eyeglass frames, tie tacks, or any other apparel that could be used to harbor a recording device. Proctors will ask to inspect any such items in candidates pockets. If prohibited items are found during check-in, candidates shall put them in the provided secure storage or return these items to their vehicle. PSI will not be responsible for the security of any personal belongings or prohibited items. Any candidate possessing prohibited items in the examination room shall immediately have his or her test results invalidated, and PSI shall notify the examination sponsor of the occurrence. Any candidate seen giving or receiving assistance on an examination, found with unauthorized materials, or who violates any security regulations will be asked to surrender all examination materials and to leave the examination center. All such instances will be reported to the examination sponsor. Copying or communicating examination content is violation of a candidate s contract with PSI, and federal and state law. Either may result in the disqualification of examination results and may lead to legal action. Once candidates have been seated and the examination begins, they may leave the examination room only to use the restroom, and only after obtaining permission from the proctor. Candidate will not receive extra time to complete the examination. TAKING THE EXAMINATION The examination will be administered via computer. You will be using a mouse and computer keyboard. IDENTIFICATION SCREEN You will be directed to a semiprivate testing station to take the examination. When you are seated at the testing station, you will be prompted to confirm your name, identification number, and the examination for which you are registered. TUTORIAL Before you start your examination, an introductory tutorial is provided on the computer screen. The time you spend on this tutorial, up to 15 minutes, DOES NOT count as part of your examination time. Sample questions are included following the tutorial so that you may practice answering questions, and reviewing your answers. The Function Bar at the top of the sample question provides mouse-click access to the features available while taking the examination. TEST QUESTION SCREEN The Function Bar at the top of the test question provides mouse-click access to the features available while taking the examination. One question appears on the screen at a time. During the examination, minutes remaining will be displayed at the top of the screen and updated as you record your answers. IMPORTANT: After you have entered your responses, you will later be able to return to any question(s) and change your response, provided the examination time has not run out. WWW.PSIEXAMS.COM 4

SCORE REPORTING Your score will be given to you immediately following completion of the examination. The following summary describes the score reporting process: - If you pass, you will receive a successful score report. - If you do not pass, you will receive a diagnostic report indicating your strengths and weaknesses by examination type on the score report. DUPLICATE SCORE REPORTS You may request a duplicate score report after your examination by emailing scorereport@psionline.com or by calling 800-733-9267. EXPERIMENTAL ITEMS In addition to the number of examination items specified in the "Examination Content Outlines", a small number (5 to 10) of "experimental" questions may be administered to candidates during the examinations. These questions will not be scored. The administration of such unscored, experimental questions is an essential step in developing future licensing examinations. NATIONAL COSMETOLOGY THEORY EXAMINATION CONTENT OUTLINE AND REFERENCE MATERIAL The National Cosmetology examination is the national licensure examination for Cosmetology, which is developed and administered by the National-Interstate Council of State Boards of Cosmetology (NIC). For more information on the examination content outlines for cosmetologist, nail technician, esthetician, electrologist and barber stylist go to www.nictesting.org. WWW.PSIEXAMS.COM 5

RHODE ISLAND COSMETOLOGY REGISTRATION FORM Before you begin... Read the Candidate Information Bulletin before filling out this registration form. You must provide all information requested and submit the appropriate fee. PLEASE TYPE OR PRINT LEGIBLY. Registration forms that are incomplete, illegible, or not accompanied by the proper fee will be returned unprocessed. Registration fees are not refundable or transferable. Legal Name: Last Name First Name M.I. Social Security: - - (FOR IDENTIFICATION PURPOSES ONLY) Mailing Address: Number, Street Apt/Ste City State Zip Code - Telephone: Cell - - Office - - Date of Birth: - - MM DD YY Email Address: @ School Attended: Examination: (Please check appropriate box): Written Examination ($75.00) First time Retake Cosmetologist Electrologist Esthetician Nail Technician Barber Stylist Payment: You may pay by credit card, company check, cashier s check, money order only. Make check or money order payable to PSI. Cash and personal checks are not accepted. If paying by credit card, check one: VISA MasterCard American Express Discover Card No: Exp. Date: Card Verification No: The card verification number may be located on the back of the card (the last three digits on the signature strip) or on the front of the card (the four digits to the right and above the card account number). Billing Street Address: Billing Zip Code: Cardholder Name (Print): Signature: Complete and forward this registration form with the applicable examination fee to: PSI 3210 E Tropicana, Attn: RI COS Las Vegas, NV 89121 (800) 733-9267 Fax (702) 932-2666 www.psiexams.com WWW.PSIEXAMS.COM 6

EXAM ACCOMMODATIONS OR OUT-OF-STATE TESTING REQUEST FORM All examination centers are equipped to provide access in accordance with the Americans with Disabilities Act (ADA) of 1990. Applicants with disabilities or those who would otherwise have difficulty taking the examination may request exam accommodations. Candidates who wish to request exam accommodations because of a disability should fax this form and supporting documentation to PSI at (702) 932-2666. Requirements for exam accommodation: You are required to submit documentation from the medical authority or learning institution that rendered a diagnosis. Verification must be submitted to PSI on the letterhead stationery of the authority or specialist and include the following: Description of the disability and limitations related to testing Recommended accommodation/modification Name, title and telephone number of the medical authority or specialist Original signature of the medical authority or specialist Date: SS#: Legal Name: Last Name First Name Address: Street City, State, Zip Code Telephone: ( ) - Home ( ) - Work Email Address: Check any exam accommodations you require (requests must concur with documentation submitted): Reader (as accommodation for visual impairment or learning disability) Large-print written examination Extended time (Additional time requested: ) Other *Out-of-State Testing Request (this request does not require additional documentation) Site requested: *You may email your out-of-state request to OutofStateRequest@psionline.com. Complete and fax this form, along with supporting documentation, to (702) 932-2666 or email it to examaccommodations@psionline.com. After 4 days, PSI Exam Accommodations will email you confirmation of approval with instructions for the next step. DO NOT SCHEDULE YOUR EXAMINATION UNTIL THIS DOCUMENTATION HAS BEEN RECEIVED AND PROCESSED BY PSI EXAM ACCOMMODATIONS. WWW.PSIEXAMS.COM 7

PSI Services LLC 3210 E Tropicana Las Vegas, NV 89121