Test Center Reimbursement / Stipend Request "*" 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 Address* Street Address Address Line 2 City State 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 ZIP Code Email* Which High School Did/Will You Graduate From*If you are a TheDream.US Scholar, please select that option instead of a specific high school.Please Select A SchoolAcademy for Careers in Television & Film (TvF)Alfred E. Smith CTE High SchoolAP for All - Office of Equity and AccessArchimedes Academy for Math, Science and Technology ApplicationsBayside High SchoolBronx Academy of Health CareersBronx Academy of LettersBronx Collegiate AcademyBronx High School for Medical ScienceBronx High School of BusinessBrooklyn High School for Law and TechnologyBrooklyn High School of the ArtsBrooklyn Lab SchoolBrooklyn Studio Secondary SchoolBroome Street Academy Charter High SchoolCentral Park East High SchoolClaremont International HSCollege NowDirector of Advanced Academic AccessEast Bronx Academy for the FutureEast-West School of International StudiesEmber Charter SchoolEpic North High SchoolForest Hills High SchoolFrederick Douglass Academy IFrederick Douglass Academy IIGeorge Westinghouse Career and Technical Education High SchoolGramercy Arts High SchoolHackensack High SchoolHerbert H. Lehman High SchoolHigh School for Community LeadershipHigh School for Health Professions and Human ServicesHigh School for Health, Education and Research Opportunities High School (HERO)I Have A Dream FoundationJamaica Gateway to the SciencesKIPP New York City College Prep High SchoolLaboratory School of Finance and TechnologyLaGuardia High SchoolLower Manhattan Arts Academy (LOMA)Manhattan Village AcademyMarble Hill School for International StudiesMesa Charter High SchoolMetropolitan Expeditionary Learning SchoolMott Hall Bronx High SchoolNew Directions Secondary SchoolNuasin Next Generation Charter SchoolPark East High SchoolPassages AcademyPlay Rugby Academy, NYCRenaissance High School for Musical Theater and The ArtsSouth Bronx Preparatory SchoolThe Bronx Latin SchoolThe Bronx School for Continuous LearnersThe Collegiate Institute for Math and ScienceThe DoorThe Dreamyard Preparatory SchoolThe Global Learning CollaborativeThe Heritage SchoolThe High School for Environmental StudiesThe Urban Assembly School for Applied Math and ScienceTYWLS BronxTYWLS BrooklynTYWLS East HarlemUnion Square Academy for Health SciencesUniondale High SchoolUrban Assembly School for the Performing ArtsWadleigh Secondary School for the Performing & Visual ArtsWorld Academy for Total Community Health High SchoolI am a TheDream.US ScholarWhat is your TheDream.US App ID?*Found at the top of your ISTS Portal HiddenExam(s) Taken*Hold the CTRL key (COMMAND on a Mac) and click the exams to select them. Please select all of the exams you are requesting reimbursement for. Click any item again to deselect it. Remember to keep the CTRL/COMMAND key pressed.American GovernmentAmerican LiteratureAnalyzing and Interpreting LiteratureBiologyCalculusChemistryCollege AlgebraCollege CompositionCollege MathematicsEnglish LiteratureFinancial AccountingFrench LanguageGerman LanguageHistory of the United States IHistory of the United States IIHuman Growth and DevelopmentHumanitiesInformation SystemsIntroduction to Educational PsychologyIntroductory Business LawIntroductory PsychologyIntroductory SociologyNatural SciencesPrecalculusPrinciples of MacroeconomicsPrinciples of ManagementPrinciples of MarketingPrinciples of MicroeconomicsSocial Sciences and HistorySpanish LanguageWestern Civilization I: Ancient Near East to 1648Western Civilization II: 1648 to the PresentExam 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 IIHiddenPlease Select Which Course*Select a CourseSecond attempt to obtain the required score on this exam? Yes, this is my second attempt Do you need reimbursement for a test center fee?* Yes No Test Center Fee ($)*Attached Receipt(s)* Drop files here or Select files Accepted file types: jpg, jpeg, gif, png, bmp, tiff, pdf, Max. file size: 3 MB. 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 exam Confirm your date of birth for payment processing* MM slash DD slash YYYY Request ID
