certification re-examination registration form - University of St ...

CERTIFICATION RE-EXAMINATION REGISTRATION FORMName:Address:Day Phone:( )_____-___________ Email:Circle Type of Certification: (MTC, PCC, STC, IOC)Previous Certification Exam Date:________________ Location:__________________THE AREA(S) THAT YOU NEED TO RETAKE:WRITTEN ORAL PRACTICALBasic Science/FCO __________S1__________S1 O/P for other than MTC tracks only __________ ___________S2 __________ __________ ___________S3 __________ __________ ___________S4 __________ __________ ___________MF1 __________ __________ ___________E1 __________ __________ ___________E2 __________ __________ ___________(SEE REVERSE SIDE FOR RE-TAKE OPTIONS)If you are registering for a Certification week for re-examination, please indicate date andlocation you prefer:____________________________________________________________METHOD OF PAYMENT____Check or money order enclosed. Make checks payable to: University of St. Augustine$_____________Amount enclosed____ Charge my credit card VISA____ MASTERCARD____ DISCOVER____ AM. EXPRESS____Card #Exp. Date$___________Amount to chargeSignature:_________________________________________________1 UNIVERSITY BOULEVARD - ST. AUGUSTINE, FL 32086-5783 - (904) 826-0084 - FAX (904) 826-0085 - WEBSITE: www.usa.edu

CERTIFICATION RE-EXAMINATIONThe following re-examination options are available to students who fail portions of the Certification.A. For those who fail only one or two oral/practical exams:OPTION 1 - Retake the oral/practical at a site convenient to the examiner (of each exam to be retaken)and the student at a date and time also convenient to both (could be when the faculty member (examiner) isteaching a course near the student’s home, during an APTA conference, at the faculty member’s clinic etc.If only an oral exam is needed, there is sometimes a possibility of arranging a monitored telephoneexamination with the examiner.) - FEE $150.00 for each oral/practical to be retaken. If only an oral orpractical component is taken, the fee is $75.00.OPTION 2 - Retake the oral/practicals during a regularly scheduled Certification class. The fee forre-examination at Certification is $75 for an individual oral or practical exam with a maximumoral/practical fee of $150.00; however, if the student also chooses to attend the review days related to theexams he/she is taking, an additional $50.00 tuition for each review day will be required.B. For those who fail more than two oral/practical exams:A regularly scheduled Certification exam day (Friday or Saturday), must be attended. An exam feeof $150.00 is required to cover one or more exams and a $50.00 per review day charge required foreach review day the therapist may wish to attend.C. For those who fail written portions of the exam:OPTION 1 - Arrangements may be made to retake the failed portion(s) of the written exam with aproctor at a location convenient to the student. Librarians, Certification graduates (not employed byyour facility), faculty or others approved by the University may be utilized as proctors. Students use theProctor Request Form to submit the name of the proctor to the Retake Coordinator for approval. The examis sent directly to the proctor once date, time, and location are determined. FEE - $50.00 for each exam.OPTION 2 - Attend a regularly scheduled Certification exam and retake the portions failed. Exam feeis $50.00 per each exam taken with a maximum of $150.00. However, if the review days related to theportions failed are attended, a $50.00 per day fee is required as well.D. Certification Exam Retake PolicyUpon 2 incomplete test scores on a single component of the Certification exam (i.e. written, oral orpractical) and prior to retaking the exam, the individual will be required to do one of the followingforms of Academic Remediation which may entail an additional cost to the participant:1. Audit seminar in the subject area and/or2. Online Education