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									                                                                       Education First                                                   CLEP REGISTRATION FORM

                              1. EMU Stdnt #:          2. First Name (please print)              M.I.                 Last Name (please print)
                                  My scores will       3. Signature                                                    4. eMail Address: (Use @emich.edu if EMU student)
                              not be sent to EMU
5. Address
Street and Apt. #                                                                        City                             State                                    ZIP + 4

6. Date of Birth              7. Sex            8. Color of Hair        9. Color of Eyes    10. Telephone - Best # to Reach You                       11. Today’s Date
        /         /               M     F                                                   (           )         –                                            /            /
12. Students with documented disabilities:Check here if you need testing accommodations:                                                          13. Last four (4) digits of
                                                                                                                                                      Social Security #:
Be sure to contact your test center to make the necessary arrangements before the test date.
Each test center sets its own deadlines for submission of documentation and approval of accommodations.
14. Testing Center and Code                              15. First Choice Test Date and Time                              16. Second Choice Test Date and Time
                                                         (See EMU CLEP Brochure)                                          (See EMU CLEP Brochure)
Eastern Michigan University                 /   1201
                                                                   /         /             9:00am           1:30pm                /       /               9:00am                1:30pm

17.   Are you a DANTES-funded military examinee?                                 Yes        No          If yes, refer to pages 3, 7, and 8 of CLEP Booklet.
18.   Examination for which you are registering :                          (You must use a separate form for each exam.)
            Accounting, Financial                              Educational Psychology, Introduction to                        Management, Principles of
            American Government                                French Language                                                Marketing, Principles of
            American Literature                               Freshman College Composition                                  Microeconomics, Principles of
            Analyzing and Interpreting Literature             German Language                                                Natural Sciences
            Biology                                            History of the United States I:                                Precalculus
            Business Law, Introductory                         Early Colonization to 1877                                     Psychology, Introductory
                      Ø                                                                                                                                     Ø
            Calculus                                           History of the United States II:                               Social Sciences and History
            Chemistry                                          1865 to the Present                                            Sociology, Introductory
            College Algebra                                    Human Growth and Development                                   Spanish Language
            College Mathematics                                Humanities                                                     Western Civilization I:
                                Ø                                                                                             Ancient Near East to 1648
            English Composition                                Information Systems and Computer
            English Composition with Essay                     Applications                                                   Western Civilization II:
            English Literature                                Macroeconomics, Principles of                                  1648 to the Present

 EMU does not accept test scores of the Highlighted exams. See http://www.emich.edu/aac/clep.htm for more details.
                                                                                                                      OFFICE NOTES:
    Optional essays are required for credit at EMU.
    Please check with your school to see if the essay is required.
19.   Repeating Exams   Check here if you are repeating this exam.
      Remember, you must wait six (6) months before repeating an examination.
20.   Fee: $70 is the fee for each exam. (See Below §)
      Required Essay Fee: $10 If you are taking an exam with an optional essay, the additional fee is made payable to:
                              College-Level Examination Program.
        You must pay the exam fee on the day of the exam by:
                              credit card -- preferred method of payment (Visa, MasterCard, American Express, Discover, JCB)
                              or a check or money order payable to: College-Level Examination Program.
      Do not combine fees for multiple tests and essays even if they are to be taken on the same day.
CLEP exams and optional essays are free to eligible military personnel, and eligible civilian employees with proper military ID.
See page 3 of the CLEP booklet for eligibility details.

I understand that Eastern Michigan University reserves the right to collect a separate, nonrefundable administration fee without
prior notice. Please see the Web site: http://www.emich.edu/aac/clepreg.htm the day before your test date to see if an
administrative fee has been added.

21. Signature:                                                                                                                                Date:        /            /
                                                      Return form to Eastern Michigan University, not CLEP.
                                                           Education First                                               CLEP REGISTRATION FORM

You can use this page to enclose your registration form and mail. Or, if printed on the back side of the registration:
    1. Fold on the gray lines.
    2. Place tape on the two sides and the top.
    3. Add your return address and a US postage stamp.
    4. Mail.



                                                                             Mail or bring the form to:
                                                                             CLEP ADMINISTRATOR
                                                                             ACADEMIC ADVISING CENTER
                                                                             301 PIERCE HALL
                                                                             YPSILANTI, MI 48197


 EASTERN MICHIGAN UNIVERSITY Education First                                                                                              1e29df4e-2401-4a88-
                                                                                                                                 a139-147e3ad50a55.doc Jun-11

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