ED 192 |
CONNECTICUT STATE DEPARTMENT OF EDUCATION |
REV. 12/11 |
Bureau of Educator Standards and Certiication |
C.G.S. 10-145f |
P.O. Box 150471 – Room 243 |
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Hartford, CT 06115-0471 |
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www.ct.gov/sde |
APPLICATION FOR CONNECTICUT ACADEMIC SKILLS ASSESSMENT WAIVER
The Connecticut Academic Skills Assessment Waiver Application will not be processed until this completed application and an OFFICIAL score report are received by the Bureau of Educator Standards and Certiication. (Scores sent by waiver candidates will NOT be accepted.) See Page 6 for application directions.
PERSONAL INFORMATION (Print all information in blue ink and in uppercase letters.)
LAST NAME
FIRST NAME

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SOCIAL SECURITY NUMBER
ADDRESS (Street)
(City)
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Bachelor’s Institution Attending/Attended
BIRTH DATE (Month-Day-Year) – Required
(Apt #)
FORMER LAST NAME(S)
PHONE
(Home)
(Work)
E-MAIL ADDRESS
Race/Ethnicity |
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Native American |
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Asian/Paciic Islander |
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Black |
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(Optional) |
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White |
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5. |
Hispanic |
Essential Skills Testing Requirement Waived Based Upon (Check one):
Refer to the Testing Agency Contact List (Page 3) for directions to have an oficial score report sent to the Con- necticut State Department of Education.
PAA Complete Page 4 in order to have an oficial PAA score report sent to the Connecticut State Department of Education.
APPLICATION FOR CONNECTICUT ACADEMIC SKILLS ASSESSMENT WAIVER
The Connecticut Academic Skills Assessment Waiver Application will NOT be processed until this com- pleted application and SAT/ACT/GRE/PAA scores are received by this ofice.
A waiver is an alternative to taking and passing the academic skills tests (Praxis I – PPST) required by the State of Connecticut for prospective educators. This information is provided to those who are inter- ested in and meet the criteria to waive the academic skills test requirement.
Who Must Meet The Academic Skills Requirement?
Individuals seeking formal admission to a Connecticut college or university educator preparation pro- gram, or seeking certiication in Connecticut, must fulill the academic skills requirement by taking and passing all three Praxis I tests: reading, writing and mathematics; or by fulilling one of the waiver op- tions listed below.
A waiver may be granted by furnishing oficial* proof of having met one of the following:
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Minimum Standards For An Academic Skills Assessment Waiver |
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Combined |
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Verbal/English |
Math / |
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Analytic |
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ESLAT / |
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Test |
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Verbal/Math |
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Critical Reading |
Quantitative |
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Writing |
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TOEFL |
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Name |
Date Test Taken |
Score |
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Score |
Score |
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Score |
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Score |
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SAT** |
Prior to March 31, 1995 |
1000 |
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No less than 400 |
No less than 400 |
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On/After April 1, 1995 |
1100 |
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ACT** |
Prior to October 1989 |
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20 |
17 |
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On/After October 1989 |
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22 |
19 |
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GRE** |
Prior to October 1, 2002 |
1000 |
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450 |
500 |
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On/After October 1, 2002 |
1000 |
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450 |
500 |
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4.5 |
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PAA |
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Equivalent to 1000 |
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(refer to |
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conversion table) |
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No less than 400 |
No less than 400 |
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510 |
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*Oficial SAT, ACT, GRE and PAA scores are those scores sent directly from the respective testing company. Test score reports forwarded to the Connecticut State Department of Education from ap- plicants will only be accepted when the testing agency no longer has your test scores on ile.
**If you have taken the SAT/ACT/GRE on more than one occasion, your highest verbal score and your highest mathematics score will be combined.
PAGE 2
TESTING AGENCY CONTACT LIST
Scholastic Aptitude Test (SAT) Scores
The College Board maintains historical SAT scores on ile. Information about obtaining historical SAT results, including the score request form, is available online at: www.collegeboard.com/student/testing/ sat/scores/sending.html or call: 866-756-7346. The Program Code for the Connecticut State Depart-
ment of Education is 3132.
Mail your completed form to:
SAT Program
P.O. Box 8057
Mt. Vernon, IL 62864
American College Testing (ACT) Scores
The ACT maintains historical ACT scores on ile. Information about reporting historical ACT results, including the score request form, is available online at: www.actstudent.org/scores or call:
319-337-1313. The ACT Code for the Connecticut State Department of Education is 0625.
Mail your completed form to:
ACT Records
P.O. Box 451
Iowa City, IA 52243-0451
Graduate Record Examination (GRE) Scores
The Educational Testing Service (ETS) retains individual GRE test records for a period of ive years. If you have taken the GRE within the past ive years, please contact ETS online at: www.gre.org or call: 888-473-7267. Original reports must be ordered from ETS. Mail your completed form to ETS-ASR/ GRE, Box 371463, Pittsburgh, PA 15250-7463
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Upon receipt forward the original score report to:
Bureau of Educator Standards and Certiication
Waiver Coordinator
P.O. Box 150471, Room 243
Hartford, CT 06115-0471
Candidates who took the GRE more than ive years ago must submit an oficial transcript showing their GRE scores, or an original document of the GRE score report sent to the candidate with the Connecticut Academic Skills Assessment Waiver Application form (ED 192).
Connecticut State Department of Education
APPLICATION FOR CONNECTICUT ACADEMIC SKILLS ASSESSMENT WAIVER
Prueba de Aptitud Academica (PAA) Score Request
This form should be completed and mailed to the College Board in Puerto Rico ONLY if you received a total score on the PAA equivalent* to a score of 1000 on the Scholastic Aptitude Test (SAT), with neither the mathematics nor the verbal sub- test score below the equivalent of 400 points. Also, a minimum score of 510 on the English-as-a-Second-Language Achieve- ment Test (ESLAT) or the Test of English as a Foreign Language (TOEFL) is required.
I formally request that the College Board, Puerto Rico Ofice, forward my PAA scores to the Connecticut State Department of Education, Bureau of Educator Standards and Certiication.
PLEASE PRINT LEGIBLY AND PROVIDE AS MUCH INFORMATION AS POSSIBLE
The following information will facilitate this request.
Social Security Number: |
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Name at time of testing: |
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Date of Birth: |
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Current Name (If different from above): |
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Gender: |
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High School Attended: |
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Current Mailing Address: |
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Street: |
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City/Town: |
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Phone Number: |
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Date/Location of administration for which score report is requested:
Please mail my PAA score report to:
CONNECTICUT STATE DEPARTMENT OF EDUCATION
Bureau of Educator Standards and Certiication
Waiver Coordinator
P.O. Box 150471 - Room 243
Hartford, CT 06115-0471
*Refer to Abbreviated Equivalency Table 1. Equivalent SAT scores are determined from an expanded table.
Important: Please contact the College Board for current information on fees for score reporting:
COLLEGE BOARD
Oicina de Puerto Rico y América Latina
P.O. Box 71101
San Juan, PR 00936-8001
Phone: 787-772-1200
Fax: 787-759-8629
E-mail: PROLAA@collegeboard.org
Website: http://oprla.collegeboard.com
ED 192 – INSTRUCTIONS
REV. 12/11
C.G.S. 10-145f
HOW TO APPLY FOR A CONNECTICUT ACADEMIC SKILLS ASSESSMENT WAIVER
1.Complete form ED 192 – “Application For Connecticut Academic Skills Assessment Waiver.”
2.Mail Page 1 of the completed form (ED 192) to the address below.
3.Contact the respective testing company (SAT, ACT, GRE or PAA) and have your test scores reported to the Connecticut State Department of Education (CSDE). See contact list on Page 3. Test score re- ports forwarded to the CSDE from waiver applicants will only be accepted when a testing agency no longer has your scores on ile. Please note that it may take up to six weeks for the testing company to get your scores to the CSDE.
4.Upon receipt of your ED 192 and your SAT/ACT/GRE/PAA scores, you will be mailed written veri- ication of your Academic Skills Assessment Waiver.
If you have questions concerning the Connecticut Academic Skills Assessment Waiver, please write, phone, fax or email:
CONNECTICUT STATE DEPARTMENT OF EDUCATION
Bureau of Educator Standards and Certiication
Waiver Coordinator
P.O. Box 150471 – Room 243
Hartford, CT 06115-0471
Phone: 860-713-6969; Fax: 860-713-7017
Email: teacher.cert@ct.gov
Website: www.ct.gov/sde