Registration Form for the Paper-based GRE revised General ... - ETS

17 downloads 19 Views 222KB Size Report
GRE® revised General Test or GRE® revised Subject Test. Completing this form and submitting payment will register you for the paper-based GRE revised ...

2017-18 Registration Form for the Paper-delivered GRE® General Test To register online, visit www.ets.org/mygre. See the GRE® paper-delivered test center list at www.ets.org/gre/bulletinandforms for the locations where the test is offered. Completing this form and submitting payment will register you for the paper-delivered GRE® General Test. Once this form has been submitted, it cannot be canceled or deleted. NOTE: Be sure to complete pages 1–4 and staple the completed form before mailing. Do NOT use this form if you are requesting testing accommodations for disabilities or health-related needs. Visit www.ets.org/gre/disabilities.

If paying by credit/debit card and/or GRE voucher, mail to: ETS–GRE PO Box 6000 Princeton, NJ 08541-6000 USA

If paying by paper check or money order, mail to: ETS–GRE Box 382013 Pittsburgh, PA 15251-8013 USA

* Required Field * ETS ID (8 characters): Create your ETS Account at www.ets.org/mygre. Once your account has been created, your ETS ID will be on the My GRE home page.

* First (Given) Name (as on photo ID document; up to 24 characters):

Middle Initial:

* Last (Family) Name (as on photo ID document; up to 32 characters):

* Address Line 1 (up to 32 characters):

Address Line 2: (up to 32 characters):

* City (up to 25 characters):

* State/Province/Territory:

* Postal Code (up to 9 characters):

* Primary Phone (Include Area Code): –

Alternate Phone (Include Area Code):





* Date of Birth (MM-DD-YYYY): –

* Country Code (Refer to www.ets.org/gre/countrycode):

* Gender (M/F):



U.S. Social Security Number:







* Email Address (up to 45 characters):

* TEST DATES – For the most up-to-date list of approved dates and locations, see the test center list at www.ets.org/gre/bulletinandforms. General Test (select one):

October 7, 2017

November 4, 2017

February 3, 2018

Copyright © 2017 by Educational Testing Service. All rights reserved.

ETS, the ETS logo and GRE are registered trademarks of Educational Testing Service (ETS)

in the United States and other countries. All other trademarks are property of their respective owners.

2017-18 Registration Form for the Paper-delivered GRE® General Test – Page 2 of 5

Name: __________________________________

* Required Field * TEST CENTER – Enter the test center’s five-digit code from the test center list at www.ets.org/gre/bulletinandforms. Test Center First Choice:

Location:

Test Center Second Choice:

Location:

SENDING YOUR SCORES – Please select the scores to be reported below. All scores will be reported unless you indicate otherwise. Options are defined as follows. • Most Recent Scores: Send scores for the General Test for which you are registering • All Scores: Send scores for all General Tests taken in the last five years, including the test for which you are registering • Do Not Send Scores (Undergraduate Institution only)

UNDERGRADUATE INSTITUTION – Using the Institution and Department Code lists at www.ets.org/gre/bulletinandforms, enter the codes for your current or most recent undergraduate institution. If you want your GRE General Test scores sent to the graduate or business school at this institution, you will need to enter the institution code in the “Score Report Recipients” section below. Institution Code

Most recent scores

Department Code Send these scores:

Undergraduate Institution:

All scores Do not send

SCORE REPORT RECIPIENTS – Using the Institution and Department Code lists at www.ets.org/gre/bulletinandforms, indicate where you would like your GRE General Test score reports sent. Institution Code

Department Code

1. Score Report Recipient:

Send these scores:

Institution Code

Department Code Send these scores:

2. Score Report Recipient:

Institution Code

Department Code

3. Score Report Recipient:

Send these scores:

Institution Code

Department Code

4. Score Report Recipient:

Send these scores:

Most recent scores All scores

Most recent scores All scores

Most recent scores All scores

Most recent scores All scores

GRE® SEARCH SERVICE – Participating in the GRE Search Service (the “Service”) is FREE for you as a GRE test taker or someone considering graduate or business school study. The Service matches prospective graduate students with participating graduate and business schools and fellowship sponsors. If you match the recruitment profile of a participating institution/organization, you may receive information about their graduate or business programs, fellowships, financial aid opportunities and other graduate education opportunities, and by signing up for the Service you give ETS permission to share your information with participating institutions/organizations. By opting in below you also agree that you may receive information regarding other products and services from ETS. If you participate in the Service, your background information, contact information and, if you have taken a GRE test, the broad score ranges in which your test scores fall will be added as criteria to the Service database. Information provided to participating schools does not include individual GRE test scores. To learn more about the Service, visit www.ets.org/gre/stusearch. Yes, I would like to register for the GRE Search Service and agree to the above.

2

No, I would not like to register for this Service.

2017-18 Registration Form for the Paper-delivered GRE® General Test – Page 3 of 5

Name: _______________________________________

* Required Field BACKGROUND INFORMATION – Please respond to ALL questions. Completed information will be used to determine suitability for inclusion in analysis samples, score interpretation data, group statistics and research studies. Individual responses are not communicated to any institution or agency if you do not participate in the GRE® Search Service. * a. Of what country are you a citizen? Find the country code from the list at www.ets.org/gre/countrycode and enter it in the boxes.

b. If you are a United States citizen, which state or U.S. Territory do you consider your permanent residence? Find the code number from the State and Territories Code list at www.ets.org/gre/bulletinandforms and enter it in the boxes.

c. If you are a United States citizen, how do you describe yourself? (Select one.)

1.

2. 3.

American Indian or Alaskan Native Asian or Asian American Black or African American

4. 5. 6.

Mexican, Mexican American or Chicano Native Hawaiian or Other Pacific Islander Puerto Rican

7. 8. 9.

Other Hispanic, Latino or Latin American White (non-Hispanic) Other

* d. Educational status at the time you take the GRE test (select one). 2. 3. 4.

Sophomore (second year) Junior (third year) Senior (fourth or final year)

5. 6. 7.

First-Year Graduate Student Second-Year Graduate Student Unenrolled (College Graduate)

Unenrolled (Master’s Degree) Other

8. 1.

* e. Do you communicate better (or as well) in English than in any other language? Yes

No

f. What is your native language? Find your native language from the Native Language Code list at www.ets.org/gre/bulletinandforms and enter it in the boxes.

g. What is (are) your reason(s) for taking the GRE tests? (Select all that apply.) 1. 2. 3.

Admission to graduate or business school (e.g., M.A., M.B.A., Ph.D.) Fellowship/scholarship application requirement Undergraduate program exit requirement

5. 7.

Practice Other

h. Indicate the highest level of education completed by your parents or guardians. (Select only one check box in each column.) Father or Mother or Father or Mother or Parent/Guardian Parent/Guardian Parent/Guardian Parent/Guardian 6. Associate Degree 1. Grade school, primary school or less 7. Bachelor’s Degree 2. Some high school or secondary school 8. Some graduate or professional school 3. High school or secondary school diploma 9. Graduate (e.g., M.A., M.B.A., Ph.D.) or equivalent or professional degree (e.g., J.D., M.D.) 4. Vocational or technical school 5. Some college/university i. If you are a United States citizen, were you eligible for a Pell Grant as an undergraduate? 1.

Yes

2.

No

3.

I don’t know

j. Referring to the Department and Major Field Code list at www.ets.org/gre/bulletinandforms, indicate your undergraduate major field of study.

k. What is/was your grade point average in your undergraduate major field of study? (If your college/university does not use letter grades, please mark the letter grade that is the closest equivalent to your grade average.) 7.

A

6.

A-

5.

B+

4.

B

3.

B-

2.

C+

1.

C or lower

B

3.

B-

2.

C+

1.

C or lower

l. What is/was your overall undergraduate grade point average? 7.

A

6.

A-

5.

B+

4.

m. In what calendar year did you receive or do you expect to receive your bachelor’s degree?

* n. Referring to the Department and Major Field Code list at www.ets.org/gre/bulletinandforms, indicate the field in which you plan to do your graduate work. If you are undecided, use 0000.

o. Please indicate any currently documented visual, physical, hearing or learning disabilities you have. (Select only one.) 1. 2.

None Blind/visually impaired

3. 4.

Deaf/hard of hearing Physical disability

5. 6.

Learning disability Multiple disabilities

7.

Other

p. In what type of graduate or business school program do you plan to enroll (or are you enrolled)? 1.

Full time

2.

Part time

3.

Undecided

3

2017-18 Registration Form for the Paper-delivered GRE® General Test – Page 4 of 5

Name: _______________________________________

* Required Field q. What is your eventual graduate education objective? 1. 2. 8.

Nondegree graduate study Master’s (e.g., M.A., M.S., M.Ed.) Specialized master’s in business

7. 3. 4.

M.B.A. 5. Intermediate (e.g., Graduate Certifcate, Specialist) 6. Doctorate (e.g., Ph.D., Ed.D.)

Not currently planning graduate study Postdoctoral study

r. In what geographic region(s) would you prefer to attend graduate school? (Select all that apply.) In the United States: 1. 2. 3. 4. 5. 6.

Outside the United States:

Northeast (CT, ME, MA, NH, RI, VT) Mid-Atlantic (DC, DE, MD, NJ, NY, PA) South (AL, FL, GA, KY, LA, MS, NC, SC, TN, VA, WV) Midwest (IL, IN, IA, KS, MI, MN, MO, NE, ND, OH, SD, WI) Southwest (AZ, AR, NM, OK, TX) West (AK, CA, CO, HI, ID, MT, NV, OR, UT, WA, WY)

8. 9. 10. 7. 11. 12. 13. 14.

Africa Asia Australia/New Zealand & Pacifc Islands Canada Eastern Europe and Russia Mexico, Central America, South America and the Caribbean Middle East Western Europe

s. Indicate your intended date of enrollment in graduate school. (Select only one.) Jan.–May June–Aug. Sept.–Dec. 2017 2017 2018 2018 2018 2019 2019 2019 2020 2020 2020 t. Indicate how many years of post-graduate full-time work experience you have. ETS Use Only

u. How would you like to pursue your graduate/business degree? 1.

On campus

2.

Online

3.

A combination of both

4.

ASR_____ FR_____ T_____ H_____ M_____

Undecided

AMOUNT

TEST FEES AND ORDER INFORMATION Paper-delivered GRE General Test* DIRECTIONS: Fill in the dollar amounts for all items that apply. Make remittance payable to ETS-GRE. DO NOT SEND CASH. Voucher/Promotional Code If using a voucher/promotional code, enter below.

Australia ............................................................... US$230 $ _______ All other areas of the world .................................. US$205 $ _______ Standby Registration* .....................................Add US$50 $ _______ Voucher/Promotional Value (if applicable) ...................... $ _______ Subtotal .............................................................................. $ _______ Tax**.................................................................................... $ _______ TOTAL AMOUNT ENCLOSED............................................ $ _______ *Fees are subject to change without notice. **Add Value Added or similar taxes where applicable (see www.ets.org/gre/fees).

If paying by credit/debit card, indicate which card you are using:

American Express®

Discover®

JCB®

MasterCard®

Visa®

Enter your card number and expiration date below. Your credit/debit card account will be billed for all services you request on this form. Credit/debit Card Number:

Expiration Date: _____ _____ Month Year If you send a check to us, you authorize ETS to convert the check into an electronic fund transfer. Please be aware that your bank account may be debited as soon as the same day we receive your payment and you will no longer receive a canceled check. If you do not have sufficient funds in your account, an additional service fee of US$20 will be added to your account. I consent to the terms and conditions outlined in the Consent Policy attached on page 5 of this form. Please write, DO NOT PRINT, the following statement. I hereby agree to the conditions set forth in the 2017-18 GRE Information Bulletin and on the GRE website, specifcally those concerning test administration, payment of fees, the reporting of scores and the confdentiality of test questions. I certify that I am the person who will take the test at the center and whose name and address appear on this form.

Signature:

4

Date:

2017-18 Registration Form for the Paper-delivered GRE® General Test – Page 5 of 5

CONSENT POLICY Notwithstanding anything to the contrary in any other ETS or ETS affiliate’s (“ETS,” “we,” “us,” “our”) materials or agreements with you, you consent to the terms and conditions herein by registering for or taking an ETS test, creating an online account or using our Website, providing survey information or requesting one of our services or completing order or payment information. You agree that we have the right to obtain, store (only for as long as necessary), use and transmit your personal information including your full name, home address, email address, telephone number, Social Security number, passport number, biometric data such as fngerprints, audio recordings and video fles, your answers to other background information questions, the test you are registering for, test date, payment information, and how you specifcally use our Website (“Personal Information”). We use your Personal Information to: • complete any registration, purchases or other transactions you request online • improve our products and services, and identify, develop and offer new or expanded products and services • improve and personalize your experience on the Website • notify you about updates, products, services and/or special offers from ETS, its affiliates and selected third parties • ask you to participate in brief surveys or provide other information • generate aggregate statistical studies and conduct research ourselves or jointly with others related to our products and services and the use of our Website Based upon your specifc relationship(s) with us for a particular product or service, we may use your Personal Information in ways described in more detail in one or more other agreements. Additionally, you consent to the transfer of your Personal Information within and outside of your country of residence and outside of the location where you have taken the test(s). We disclose your Personal Information to certain third parties with whom we have a direct or indirect business or contract relationship, to provide the products and services you have requested. You will have the ability to opt out of receiving certain communications from us, including voicemail or email. If you do not opt out immediately, but later decide that you would prefer not to receive email communications from us, please contact that particular testing program through www.ets.org. Remember, however, that we may still send email or call you in order to provide a product or service that you request. Australia requires ETS to provide notifcation to AU residents. For Australian residents only, please be informed that if you consent to the overseas disclosure of the information or transfer of your data outside of Australia, ETS and its affiliates will not be required to take reasonable steps to ensure that ETS or its affiliates’ use of such data outside of Australia does not breach the Australian Privacy Principles. By indicating “Accept,” you consent to the terms and conditions above and those more fully outlined in the ETS Privacy Policy located at www.ets.org/legal/privacy or attached hereto for paper-delivered assessments.

122496-98134 • UNLWEB817

5