PDF《REQUEST焖ORM》

24 \ Official Score Report Request Form www.

ets.org/toefl 2011-12 TOEFL iBT Bulletin ? ? ? ? ? ? ? ? ? ? ? ? ? ?? ? ? ? ? ? ? ? ? ? ? ? ? ? RT ) ? a n d ? Q S T ?(Reg.?No.?1087967545t otal? ? ? ? ? ? TOEFL iBT ? SCORE REVIEW REQUEST FORM Check the appropriate box, complete the form, and follow the submission instructions below. I request that the following test section scores be reviewed for the test date indicated below: Speaking and Writing (US$160) Speaking (US$80) Writing (US$80) Test Date: Month Day Year Registration Number: Name: Date of Birth: Month Day Year Address (include ZIP or postal code): Check this box if your mailing address has changed since the test date indicated above. Print your new address below. Address (include ZIP or postal code): Check if paying by American Express? Discover? JCB? MasterCard? VISA? Credit/Debit Card Number Expiration Date ― Month Year Copyright ?

2017 byEducational Testing Service, Princeton, NJ. CUT HERE # SUBMITTING THE TOEFL iBT SCORE REVIEW REQUEST FORM Complete the form and send it with the required fee to: TOEFL? Services ETS PO Box

6151 Princeton, NJ 08541?6151 USA NOTE:?Only?1?score review?request?per?test?administration?can?be?submitted.?Checks?must?be?in US$ and payable?to ETS?TOEFL. NOTE: YOUR SCORES CANNOT BE REVIEWED IF YOU ALREADY REQUESTED THEY BE SENT TO AN INSTITUTION OR AGENCY. By sending your check, you authorize Educational Testing Service (ETS) to convert the check into an electronic funds transfer. Please be aware that your bank account may be debited the same day we receive your payment and you will not receive a canceled check. If you are paying by credit/debit card, this form may be faxed. Faxed requests will not be processed unless complete credit/debit card information is provided. The fax number is 1?610?290?8972. The results of the rescoring process will be? available approximately 3? weeks after receipt of your Request Form and payment.? NOTE: All forms will be processed upon receipt, and a charge will be made to your credit/debit card. If you think your faxed form may not have been received by TOEFL Services, and you attempt to send the information again, write "DUPLICATE" in large letters on all repeat requests. This will help avoid extra processing by TOEFL Services and unnecessary charges to your credit/debit card.