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

Verification of Assessment Center Eligibility Form
(required only of institutions that qualify as assessment centers)

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:


      As defined in the Federal Register, I understand that a qualified assessment center
 (1) is located at an eligible institution that provides two-year and four-year degrees,
      or qualifies as an eligible public vocational institution, i.e. a "postsecondary vocational institution."
 (2) is responsible for gathering and evaluating information about individual students for multiple
      purposes, including appropriate course placement;
 (3) is independent of the admissions and financial aid processes at the institution at which it is located;
 (4) is staffed by professionally trained personnel; and
 (5) does not have as its primary purpose the administration of ability-to-benefit tests.

I hereby verify that this institution qualifies as having an assessment center according to the definition
listed above. I further agree to adhere to the testing guidelines described in the CELSA Test
Administrator’s Manual and Technical Guide for Ability to Benefit (January, 2000). If scoring is
to be done in the assessment center, I further agree to provide ACTT on an annual basis with a list or electronic
file with the names and identification numbers of all students who take the CELSA for ATB purposes,
the CELSA form number for each, and the name of the institution the score was reported to.
(U.S. Dept. of Education requirement for publisher reporting).


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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