Please provide the following informaiton. Any piece of information with an * beside it must be filled out or the form cannot be submitted. NOTE: ALCPTs are not sold to individuals, only to organizations with a bona fide need for English-proficiency testing; this form is for use by their POCs only.
| *1. Date of request :
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| 2. Your data: |
| *a. Name:
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| *b. Rank/title
:
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*c. Position:
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*d. E-mail address:
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| *e. Commercial phone number:
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| f. Commercial FAX:
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| g. DSN prefix
:
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| 3. Organization on whose behalf you are requesting the test:
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| *a. Full Name of user unit:
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| *b. Commercial phone:
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| c. Commercial FAX
:
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| d. DSN prefix:
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| *e. Complete mailing address :
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| *f. Complete physical address :
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| 4. Justification for requesting the tests. If the information provided is not sufficient, or if it is not made clear who will have control of ALCPT testing, we may not be able to approve your request.
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*a. For what purpose does the user unit need the tests?
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*b. Who will the examinees be?
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| *c. Approximately how many examinees will be tested per year?
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| *d. Approximately how often will the test be administered?
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| 5. ALCPT security:
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| *a. Where will the materials be stored?
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| *b. How will the materials be secured?
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*c. Who will have overall responsiblity for ALCPT testing?
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*d. Who will be appointed ALCPT Test Control Officer?
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| *e. What procedures does the unit have (or wil it put) in place to limit access to test materials and to ensure test security? Please provide details.
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| 6. ALCPT inventory:
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*a. Has the user unit ever ordered ALCPTs in the past?
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| *b. Does the user unit have any ALCPTs in its inventory at this time?
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| If "b" is yes, which forms?
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*c. Which ALCPT kits is the unit interested in acquiring at this time?
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| 7. Caveat for prospective ALCPT users:
Upon obtaining ALCPT materials, the user unit enters into a tacit agreement to abide by the ALCPT guidance and to maintain the materials secure, not to allow access to them by unauthorized parties, not to allow them to be duplicated, not to permit them to be transferred to another location or unit without notifying DLIELC, and especially not to use them for any teaching or training purposes, only for the proficiency testing purpose for which they were designed. Failure to maintain the materials secure may result in disapproval of release of any additional ALCPT materials to the user unit.
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8. Notice to prospective ALCPT user units that are also ordering ALC books and other curriculum support materials:
Unlike requests for purchase of ALC books and curriculum support materials, requests for ALCPT purchase must be preapproved by the DLIELC Testing office (LEAT) before the DLIELC warehouse can ship them. If your unit is ordering ALCPTs as part of a large order of ALC book/curriculum support material, and the testing and non-testing material is to be shipped togerther, please ensure that you obtain approval to purchase the ALCPT test material PRIOR TO submitting your book order to the warehouse, so as to avoid any delays in shipment of your complete order.
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