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NABCEP Entry Level Exam CANDIDATE ELIGIBILITY FORM Please PRINT all information clearly. This form must be signed and filled out in its entirety. Instructor Name IMPORTANT AFTER A PAPER AND PENCIL EXAM ADMINISTRATION THE IDENTIFICATION NUMBER MUST BE TRANSFERRED TO THIS FORM FROM THEIR ANSWER SHEET IN ORDER FOR SCORES TO BE PROCESSED Candidate Eligibility Form NABCEP 2011 PV Entry Level Exam Solar Heating Cooling Candidate ID Page 1 of 1. Initial the box to the right if you plan on requesting special accommodations for the NABCEP Entry Level Exam. A Special Accommodation Request form will need to be filled out and submitted to NABCEP along with supporting documentation from a qualified professional before any accommodations are granted. Release of Scores NABCEP releases the individual score results to the registered Entry Level Exam Provider for all of the candidates that the Provider confers eligibility to. If you would prefer to not have your score released to the Provider you may opt-out by initialing the box to the right. By signing below I acknowledge that I have received and read the NABCEP Entry Level Exam Candidate Information Sheet and the NABCEP Entry Level Exam Learning Objectives. Name In the boxes below enter your name exactly as it appears on your Government Issued Photo ID. NOTE If the name does not match your Photo ID you will not be admitted into the Exam* Last Name First Name MI An E-mail Address is required in order to receive communications from NABCEP about the Entry Level Exam* The e-mail will not be used for any other purpose. NOTE your eligibility cannot be processed without an email* E-mail Mailing Address In the boxes below enter the mailing address that should be used to send Passing Achievement Documents if you pass the Exam* Street 1 City State Zip Check the box next to the format of the Exam that you plan to take Note the Computer Based Testing Exam costs 95 and Providers can charge up to an additional 25 administrative fee Paper and Pencil Exams cost 75 and Providers can charge up to an additional 75. Paper Pencil with my Provider Computer Based with Prometric Special Accommodations are available for individuals who can document a physical mental or learning disability that qualifies under the Americans with Disability Act. Initial the box to the right if you plan on requesting special accommodations for the NABCEP Entry Level Exam* A Special Accommodation Request form will need to be filled out and submitted to NABCEP along with supporting documentation from a qualified professional before any accommodations are granted* Release of Scores NABCEP releases the individual score results to the registered Entry Level Exam Provider for all of the candidates that the Provider confers eligibility to. If you would prefer to not have your score released to the Provider you may opt-out by initialing the box to the right. By signing below I acknowledge that I have received and read the NABCEP Entry Level Exam Candidate Information Sheet and the NABCEP Entry Level Exam Learning Objectives.

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