New Mexico Higher Education Department | NM Higher ...
5302250000New Mexico Higher Education Department Dyanne Salazar, High School Equivalency (HSE) Administrator 2044 Galisteo Street Suite 4Santa Fe, NM 87505 HSE Test Voucher ApplicationFirst Name: ___________________________MI:_____ Last Name: ________________________________________Address: ________________________________________________________________________________________City: ___________________________________________________ State: ____________ Zip Code: ______________Phone Number: ______________________________ Alternate Phone Number: ______________________________Email Address: _______________________________________________ Date of Birth: ________________________Information above MUST be correct to receive the voucher. Voucher information will be sent to the email address listed.Which test are you requesting a free testing voucher for? CHECK ONE: Educational Testing Service (HiSET?) ___or Pearson Vue (GED?) ____ For more information about both tests click hereIf you are age 16-18: You must take your HSE test at a state-approved Testing Center, and that Testing Center will need a copy of your Underage Permission Form. English and Spanish versions of the Underage Permission Form can be found here: English Version Spanish VersionFor a complete list of Test Center locations and contact information click hereIf you are over age 18: Do you want a voucher to take the HSE test in person at an approved testing center, or remotely (i.e. on your own computer at home)? If remotely, you are responsible for remote proctoring fees. ($17.00 per module) CHECK ONE: Remote Proctoring* _______ or Approved Testing Center ______ *If you choose the Remote Proctoring option, you must attach a copy of your VALID STATE ID to receive a voucher.Regardless of age: To be eligible to receive a voucher, you will need to take an Official Practice Test for the HiSET? or GED?. Scores must demonstrate test readiness according to test publisher guidelines. Sign and submit this form with all necessary documentation to: dyanne.salazar@state.nm.us. If you have questions, you can call Dyanne Salazar directly at 505-269-3074I verify that all information above is correct: ________________________________________________________left282575APPLICANT: PLEASE FILL IN OFFICIAL PRACTICE TEST SCORES BELOW & ATTACH COPY OF SCORE REPORT TO VERIFYWhich Official Practice Test did you take? ? GED? or ? HiSET? Official Practice Test Scores: Writing ScoreLanguage ArtsMath Social StudiesScience(HiSET? only)ScoreScoreScoreScore I approve the student listed above to receive a voucher to take the HSE exam:HSE State Administrator SignatureDate0APPLICANT: PLEASE FILL IN OFFICIAL PRACTICE TEST SCORES BELOW & ATTACH COPY OF SCORE REPORT TO VERIFYWhich Official Practice Test did you take? ? GED? or ? HiSET? Official Practice Test Scores: Writing ScoreLanguage ArtsMath Social StudiesScience(HiSET? only)ScoreScoreScoreScore I approve the student listed above to receive a voucher to take the HSE exam:HSE State Administrator SignatureDateStudent Signature + Date ................
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