CSET: LOTE Exam Voucher Request Form

2015-2016 Master Plan Verification CSET: LOTE Exam Voucher Request Form

Name: ______

School: ______Location Code: ______

Employee number: ______Social Security Number: ______

Daytime contact phone number: ______

E-Mail address: ______

Select the test date month for which you are requesting a voucher: □ November 2015 □ January 2016 □ March 2016 □ May 2016 □ July 2016 You are committing to take the exam in the test date month you selected above.

Candidate ID: ______(You will obtain your Candidate ID upon registration for the test at www.ctcexams.nesinc.com. Our office will NOT be able to process a voucher request without a Candidate ID.)

Place a check mark next to the tests for which you are requesting a voucher: FOR MPVU USE ONLY: CSET: LOTE Subtest IV Assesses the Methodology Entered: Formerly known as BCLAD TEST 4; Methodology of Bilingual Education for Primary Language Instruction

CSET: LOTE Subtest V Entered: Formerly known as BCLAD TEST 5; The Culture Assesses Bilingual of Emphasis = Indicate the language for which you Cultural Knowledge are seeking BCLAD certification. CSET: LOTE Subtest II or Subtest III Assesses Language Entered: Formerly known as BCLAD TEST 6; Language of and Communication Skills Emphasis = Listening/Reading/Speaking/Writing

Please indicate how you qualify for a voucher:

 Completed and passed the District Fluency Exam at the “A” or “B” Level.

 Completed Los Angeles County Office of Education (LACOE) Training Courses

Dates Training Completed: ______

Upon completion and verification of required training, the voucher number will be sent via the email address you provided unless you indicate otherwise. YOU are responsible for ensuring that your registration along with the voucher number is complete with NES on or before their posted registration deadline of the individual test date. LAUSD will NOT pay any additional fees or late fees for your registration.

Signature: ______Date: ______

Return this Voucher Request Form via fax at (213) 241-8412 or by school mail to

LAUSD/HR Form 1315 09/2012 Master Plan Verification, Certificated Employment Operations, Beaudry Building, 15th Floor.