Test Center Reimbursement / Stipend Request 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 Last Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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)Archimedes Academy for Math, Science and Technology ApplicationsBayside High SchoolBronx Academy of Health CareersBronx Academy of LettersBrooklyn High School of the ArtsBrooklyn Lab SchoolBrooklyn Studio Secondary SchoolBroome Street Academy Charter High SchoolCentral Park East High SchoolEast Bronx Academy for the FutureEast-West School of International StudiesEmber Charter SchoolEpic North High SchoolForest Hills High SchoolFrederick Douglas Academy IIGeorge Westinghouse Career and Technical Education High SchoolHerbert H. Lehman High SchoolHigh 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 SchoolLaGuardia High SchoolLaboratory School of Finance and TechnologyLower Manhattan Arts Academy (LOMA)Manhattan Village AcademyMesa Charter High SchoolMetropolitan Expeditionary Learning SchoolMetropolitan Lighthouse Charter SchoolNew York EdgePark East High SchoolPlay Rugby Academy, NYCRenaissance High School for Musical Theater and The ArtsSouth Bronx Preparatory SchoolTYWLS BronxTYWLS BrooklynTYWLS East HarlemThe Bronx Latin SchoolThe Collegiate Institute for Math and ScienceThe Heritage SchoolThe High School for Environmental StudiesThe Urban Assembly School for Applied Math and ScienceUnion Square Academy for Health SciencesUrban Assembly School for the Performing ArtsI 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 GovernmentAnalyzing and Interpreting LiteratureBiologyCalculusChemistryCollege AlgebraCollege CompositionHistory of the United States IHistory of the United States IIIntroductory PsychologyIntroductory SociologyNatural SciencesPrecalculusPrinciples of MacroeconomicsPrinciples of MicroeconomicsSpanish LanguageOther Course (Requires Approval)Exam Taken*Select a CourseAmerican GovernmentAnalyzing and Interpreting LiteratureBiologyCalculusChemistryCollege AlgebraCollege CompositionHistory of the United States IHistory of the United States IIIntroductory PsychologyIntroductory SociologyNatural SciencesPrecalculusPrinciples of MacroeconomicsPrinciples of MicroeconomicsSpanish LanguageOther Course (Requires Approval)Please Select Which Course*Select a CourseAmerican 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 PresentSecond 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 Request ID