<p> Appendix 1-A Revised 04/2014</p><p>(Shaded areas are to be completedRevised by03/2014 Test Coordinator or Examiner) West Virginia TASC Form UUID: ______Mountaineer Challenge Academy Form: ______</p><p>PLEASE PRINT LEGIBLY Social Security Number: ______- __ __ - ______TASC Candidate First Name: ______Last Name: ______Date of Birth: __ __ /__ __ /______Gender: M  FAge: ____ ABE  Option Pathway  Neither  Email Address: ______Phone Number: (______) ______- ______Cell Number: (______) ______- ______Diploma: Mailing Address or PO Box ______City: ______County: ______State: ______Zip Code: ______</p><p>TASC – To be completed by TASC Examinee (Shaded areas are to be completed by Test Coordinator or Examiner) Is the candidate named above retesting? Yes  No  The candidate named above will be taking: Form Form Form Reading  Math  Social Studies  Writing  Science  UUID (TASC ID) </p><p>TASC Testing Information – To be completed by TASC test-taker</p><p> Taking the entire test for the first time, or  Retesting and have completed the test, or  Taking some of the tests to complete the battery.</p><p>If you have tested before, name the state/s where you tested ______. VOUCHER–To be completed by MCA instructor</p><p>The candidate named above is a first time tester or last tested in the state of ______and has scored a minimum on the TRA: Math 6 pts Reading 8 pts Science 6 pts Social Studies 7 pts Writing 11 pts 63%  69%  59%  53%  56%   Working toward the completion of a TASC preparation program at MCA.  Working toward the completion of a MCA Option Pathway preparation program.  Prior to retesting waited 30 days, returned to MCA class and completed a TASC preparation program.</p><p>Signature of MCA Instructor: ______</p><p>SIGNED RELEASE –The TASC Candidate must check and sign this release section.</p><p> I understand that the local and state TASC examiners, accredited schools that I attended, Mountaineer Challenge Academy and workforce agencies with which data sharing agreements exist for the purposes of meeting national performance measurement standards will automatically have access to my records.</p><p> I affirm that I agree to the terms set forth by TASC, the West Virginia TASC Testing Office, and the local jurisdictions that were viewed during my online registration. Signature of TASC Candidate: ______Date: ______</p><p>ATTACH A COPY OF CURRENT & VALID STATE OR FEDERAL ISSUED ID TO THIS FORM ID MUST BE PRESENTED DURING EACH TESTING SESSION</p><p>*TASC candidates sixteen (16) years of age placed in an IEP, Mountaineer Challenge Academy or Job Corps may take the TASC Tests without an approved waiver from the WVDE. Nevertheless, the status of the sixteen (16) year old during the school term must follow the guidelines set forth by the West Virginia Legislature. Please, refer to GUIDELINES FOR ALLOWING A SIXTEEN (16) YEAR OLD TO TAKE THE TASC® TESTS School-Term 2010-2011 through School Term 2013-2014.</p>