Please Print out Form and Return to ACTT (or Fill in and Submit Online)

Independent Test Administrator at Assessment Center Certification Form
(required only of institutions that do not qualify as an assessment center)

CELSA ESL test for ATB purposes


Institutional information:

Name of institution(s) for which you will be administering the ATB test:

Address of Institution:

City , State, Zip:

Office phone:

Fax number:


Personal information of proposed test administrator:
First name:

Last name:

Title:

Email address:



 # Years of post-secondary education:

 # Years experience administering tests:

 Highest degree earned:



      The proposed Test Administrator must:
 (1) Have no current or prior financial or ownership interest in the institution, its affiliates
       or its parent corporation, other than the interest obtained through its agreement
       to administer the test, and has no controlling interest in any other educational
       institution.
 (2) Not be a current or former employee of or consultant to the institution, its affiliates, or
       or parent corporation, a person in control of another institution, or a member of the family of any of these
       individuals
 (3) Not be a current or former member of the board of directors, a current
       or former employee of or a consultant to a member of the board
       of directors, chief executive officer, chief financial officer of the institution or its parent corporation
       or at any other institution, or a member of the family of of any of the above individuals
 (4) Not be a current or former student of the institution.


I understand that I will administer the CELSA tests on special forms provided by
ACTT and I will send those forms to ACTT within two working days of testing for scoring
and reporting the individual student results back to me. I also understand that I will not
be required to provide annual reports to ACTT since all scoring will be done by ACTT.

I agree to administer the tests according to ACTT guidelines provided.
In addition, as defined by 668.151 of the Federal Register (Dec. 1, 1995).


Back to the CELSA Order Page

 * Sign only if you are going to print and mail in form
    otherwise your name is documented when submitting the form online

  * Signature:_______________________________ Date:_________________________
     Title:________________________________________________________________



Association of Classroom Teacher Testers
1187 Coast Village Road Suite 1
PMB 378 Montecito, CA 93108-2794
Phone (805) 965-5704
Fax     (805) 965-5807

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