Application for an Interpreter Ethics/Knowledge Test

Have you taken this test before?        Yes        No

If yes, what was the date 

If you do not receive a passing score there is a three month waiting period before you can retest.

Name

             Last                                                          First                                                                   Middle/Maiden

Address 

                              City                                                                                    State                                               Zip

Daytime phone # (        )                                  Other #   (        )

E-mail


Social Security Number 

Preferred Testing Date 


Preferred Testing Time                                                                    Second choice of time

Accommodations Requested

Please enclose your check for $100 made out to DSS/JSU.  Registration and cashier check or money order  must be received 10 working days prior to testing date.  Upon receipt of registration and payment you will be contacted to confirmation of your test date and tim.

Mail your application to:
 Disability Support Services
  Jacksonville State University
  700 Pelham Road North
  Jacksonville, AL 36265
  (256) 782-8380
  dss@jsu.edu