Record of Examinations Requested

This form may be photocopied by the school and used in any of several ways:

As a worksheet for preparing your school’s online request for submission to the Department
For circulation to department chairpersons, special education coordinators, and other school officials for reporting their examination needs to your school’s central office on a subject-by-subject basis
For distribution to other principals in your district when your school is requesting quantities of test booklets for use in other schools

Be sure to retain in your files the final version of this
form — the one representing the completed online request actually submitted to the Department. You will need to use that version for checking your confirmation notice, which will be sent to you via e-mail within several days of the submission of your online request to the Department.

School Name

Date

* Available in Restricted Form only. Each copy of a restricted test is numbered and sealed in its own envelope and must be returned, whether used or unused, to the Department at the end of the examination period.
Building principals are responsible for returning all restricted examination materials shipped to their school.
Request only the exact number of restricted booklets required. Do not request sample copies or extra copies.

TITLE	Regular	Large Type	Braille
Comprehensive English
Comprehensive French*	*	*	*
Comprehensive Spanish
Living Environment
Physical Setting/ Chemistry
Physical Setting/ Earth Science
Physical Setting/ Physics
Mathematics A
Mathematics B
Global History & Geography
U.S. History & Govt.

TITLE	Regular	Large Type	Braille
Mathematics*	*	*	*
Science*	*	*	*
Reading
Writing
Global Studies*	*	*	*
U.S. History & Govt.*	*	*	*