Test Center Number:   STN12390                                                                                                           City:  Tehran

State/Province:           Tehran                                                                                                                  Country: Iran

 

Confidentiality Statement for TOEFL® Internet-Based Testing

I hereby agree to the policies, procedures, and general conditions set forth on the TOEFL® website and in the current year’s Registration Bulletin. These include but are not limited to those concerning the test administration, including the test procedures and regulations highlighted below, the payment of fees, the test retake policy, and the reporting or cancellation of scores. I have read and understand the procedures and regulations shown below. I certify that I am the person who will take the test at this center and whose name appears on the application check-in screen. I agree to maintain the full confidentiality of all test questions, specifically not to reproduce and/or disclose any test question in whole or in part to any person or entity, and understand that if I reproduce test questions in any manner I may be subject to a copyright infringement lawsuit and any other action(s) ETS may take in order to protect its intellectual property rights. I understand that providing false information on this form may lead to cancellation of my test scores by ETS. I understand that if I do not agree to these conditions, I will not be permitted to test and my fee will not be refunded. I also understand that if I repeatedly violate any of the policies or procedures listed on the website and in the Registration Bulletin, I may be prohibited from any future testing.

Please write, DO NOT PRINT, the following statement. Sign and date the statement where indicated.

“I agree to the conditions printed and referenced above and certify that I am the person who will take the test at this center and whose name appears on the application check-in screen. I agree to maintain the full confidentiality of all test questions, specifically not to reproduce or disclose any test question in whole or in part to any person or entity in any form.”

                                                                                                                                                                                          

                                                                                                                                                                                          

                                                                                                                                                                                          

                                                                                                                                                                                          

                                                                                                                                                                                          

                                                                                                                                                                                          

                                                                                                                                        

Printed Name: ___________________________    Are you testing today in your country of citizenship?      Yes5No5

Signature:                                                                                                       Date:____________

 

Test Center Procedures and Regulations – Highlights

PLEASE READ CAREFULLY

The test administrator is authorized to dismiss you from a test session and/or ETS may cancel your scores for reported violations of these procedures and regulations. If cancellation should be necessary, no scores will be reported and your test fee will be forfeited.

 

1.    You are not permitted to eat, drink, or use tobacco in the testing room.

2.    You are not permitted to use telephones or cell phones during the test session or during breaks.

3.    You are not permitted to leave the test center during the test session or during breaks.

4.    You may not refer to or use any prohibited testing aids (as listed on the website and in the Registration Bulletin) during the test session or during breaks.

5.    The time limit for the scheduled break will be stated on the directions screen. You must not exceed the time allotted for the break. Violations will be documented by the test administrator and reported to ETS.

6.    Repeated or lengthy departures from your workstation for unscheduled breaks will be documented by the test administrator and reported to ETS.

7.    You may not communicate with anyone about the content of the test.

8.    You must have valid and acceptable ID to take the test. Remember to keep your ID with you at all times.

9.    You may take the test only once in any seven-day period.