CTAS Contact Form

Page 1

Take the first step on your journey to become a CTAS by completing this application form.

If you encounter difficulty submitting this form, please scan the form and email to CTAS@ets.org, or print the form and fax to 1-609-406-5360.

* Indicates required fields.

Step 1: Your Information

Referral ID

(if provided by ETS)

Prefix (Mr., Mrs., Ms., etc.)

First Name

Last Name

Suffix

Job Title

Department

Email Address

Phone

Are you the primary decision maker?

YesNo

If you are not the primary decision maker, please indicate the primary decision maker’s name and contact information below.

Prefix (Mr., Mrs., Ms., etc.)

First Name

Last Name

Suffix

Job Title

Department

Email Address

Phone

Step 2: Test Site Location and Institution Shipping Address

Test Site Location

Please list the address where test takers will report on test day.

Country

Institution Name

Address - P.O. Boxes are not acceptable.

Address Line 2

Address Line 3

City

State

Provinces

State/Province/Prefecture

ZIP / Postal Code

Organization Type

Institution Shipping Address

Same as Test Site location

YesNo

Country

Address

Address Line 2

Address Line 3

City

State

Provinces

State/Province/Prefecture

ZIP / Postal Code

Step 3: Background and References

What are the advantages to ETS test takers to have a test center at your test site location?

Is your organization now or have they ever been affiliated with ETS directly or with any ETS affiliated organizations?

YesNo

List one to three references for your institution, such as educational accreditation status by a government organization, official educational accreditation agency or membership association. For each reference, please include the agency name and contact information.

How many years has your organization been in operation?

How many years has your organization been at your current location?

If available, please provide the URL for your institution/organization.

If the applicant doesn’t have a website, they can note “None”.

Step 4: ETS Third Party Due Diligence Program

The nature of the goods or services that you seek to provide to us has triggered our compliance due diligence requirement.

The third parties who do business with us are integral to our success and the accomplishment of our mission. We look for partners who share our values and commitment to responsible, compliant, and ethical business conduct. The ETS Third Party Due Diligence Program is designed to help us identify and manage the compliance risks and obligations that may result from our engagement with you. Thank you for your participation in this review process, as it is a critical part of our selection process and in the development of a successful relationship.

a.Is your organization a state-owned or controlled enterprise?

Public institutions and State funded universities and schools are considered state-owned or controlled for the purposes of this form.

b.Are any of the organization's owners, directors, or shareholders government officials?

A government official is 1) any officer or employee of any government or any government department or agency (including such individuals who may be serving in other capacities such as an employee of a corporation who also holds a governmental post); 2) any person acting in an official capacity on behalf of any government or any government department or agency; 3) any officer or employee of a company or business owned in whole or in part by any government or government official; 4) any officer or employee of a public international organization, such as the World Bank, the United Nations, etc.; 5) any political party or any official thereof; 6) any candidate for political office; 7) civil servants; and 8) military personnel.

c.If yes to 3(b) above – Please list the owners, directors, or shareholders who are government officials. List their full legal name, job title and years of service to the government office or agency, nationality, and year of birth

First Name

Last Name

Job Title

Years of service to the government office or agency

Nationality

Year of birth

Within the last five (5) years, has the organization or any of its directors, officers, principal owners or employees, ever been found by a court or agency to have been in violation of anti-bribery, anti-fraud, anti-money laundering, modern slavery or anti-human trafficking, or privacy laws or regulations or made any public disclosures involving the same?

Step 4: Internet-delivered Testing

To administer internet-delivered tests, you will need to provide a secure room for approximately a six-hour block of time.

The TOEFL iBT ® test is typically administered on Fridays, Saturdays and Sundays. The GRE ® General Test, Praxis ® tests and Georgia Assessments for the Certification of Educators® (GACE®) Assessments are typically administered Monday through Saturday.

Which internet-delivered test(s) are you interested in administering at your site?

GACE (For U.S. stat of Georgia only)GRE General TestPraxis tests (United States only)TOEFL iBT test

Step 5: Testing Information

How many secure rooms do you have available for ETS test administrations?

How many computers are available in Room 1?

How many computers are available in Room 2?

How many computers are available in Room 3?

Are the computers in the rooms wired or wireless?

WiredWireless

On what date do you expect that you could begin participating in ETS internet-delivered test administrations?

CTAS Application Form