CLEP Test Center Reimbursement "*" indicates required fields IMPORTANT: You must have used a Modern States CLEP voucher and provide a copy of your CLEP exam score to request test center reimbursement. Please note, it takes approximately 8-10 weeks to process a reimbursement request.Name* First Middle Last Country of residence* I live in the United States I live in Canada I live in another country Address* Street Address Address Line 2 / Apartment / Suite / Floor (optional) City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCabo VerdeCayman IslandsCentral African RepublicCeuta and MelillaChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (the Democratic Republic of the)CongoCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuracaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicTimor-LesteEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (the Democratic People's Republic of)Korea (the Republic of)KosovoKuwaitKyrgyzstanLao, People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (the Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaPalestine, State ofSaint Pierre and MiquelonSudanSurinameSvalbard and Jan MayenEswatiniSwedenSwitzerlandSyrian Arab RepublicTaiwan (Province of China)TajikistanTanzania, the United Republic ofThailandTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUnited States Minor Outlying IslandsUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamVirgin Islands, BritishVirgin Islands (U.S.)Wallis and Futuna IslandsWestern SaharaYemenZambiaZimbabwe Country Email* PhoneExam Taken*Select An ExamAmerican GovernmentAmerican LiteratureAnalyzing and Interpreting LitBiologyCalculusChemistryCollege AlgebraCollege CompositionCollege Composition ModularCollege MathematicsEnglish LiteratureFinancial AccountingFrench LanguageGerman LanguageHistory of United States IHistory of United States IIHuman Growth and DevelopmentHumanitiesInfo SystemsIntro to Educational PsychIntroductory Business LawIntroductory PsychologyIntroductory SociologyNatural SciencesPrecalculusPrinciples of MacroeconomicsPrinciples of ManagementPrinciples of MarketingPrinciples of MicroeconomicsSocial Sciences and HistorySpanish LanguageSpanish With WritingWestern Civilization IWestern Civilization IISecond attempt to obtain the required score on this exam? Yes, this is my second attempt Are you a participant in an affiliated Modern States program?*Select a choiceI am not a participant in an affiliated programDetroit x Freshman Year for FreeMorgan State Fast StartNSU Fast StartNYC x Freshman Year for FreePurdue University Fast StartSUNY Empire State CollegeTalladega Fast StartTennessee Freshman Year for FreeUC Fast StartYour answer here will not affect your ability to receive a voucher and is strictly for accounting purposes.Are you a high school student?* No Yes What high school do you attend?*Select An OptionI attend another high schoolBrentwood High SchoolBriarcrest High SchoolCentennial High SchoolCollierville High SchoolFranklin High SchoolHalls High SchoolIndependence High SchoolMemphis Academy of Science and EngineeringNolensville High SchoolOverton High SchoolPage High SchoolRavenwood High SchoolSpring HIll High SchoolValor Collegiate AcademyParticipants of the NYC x Freshman Year for Free program should fill out the Test Center Reimbursement form on the NYC x Freshman Year for Free website by clicking here.Test Center Fee ($)*Test Center Receipt*Accepted file types: jpg, jpeg, gif, png, bmp, tiff, pdf, Max. file size: 3 MB.Exam Date* MM slash DD slash YYYY Exam Score*Candidate Score Report*Accepted file types: jpg, jpeg, gif, png, bmp, tiff, pdf, Max. file size: 3 MB.Voucher Number* Please enter the voucher number provided by Modern States for this examConfirm your date of birth for payment processing* MM slash DD slash YYYY Request IDParticipants of the NYC x Freshman Year for Free program should fill out the Test Center Reimbursement form on the NYC x Freshman Year for Free website by clicking here.