Edinboro University of Pennsylvania
College-Level Examination Program (CLEP) Registration Form
Registration form must be received two weeks prior to the exam date. Form can be mailed or dropped off at:
The Office of Adult Student Services, 405 Scotland Road, 211 Pogue Student Center, Edinboro, PA 16444
1. First Name
4. Birth Date
/
/
7. E-mail Address
2. M.I.
5. Telephone Number
(
)
-
9. City
3. Last Name
6.
Student ID (if you are an Edinboro Student)
@
8. Street Address
10. State
11. Zip
12. Students with documented disabilities:  Check here if you need testing accommodations. Be sure to contact the
Office of Adult Student Services to make the necessary arrangements before the exam date.
13. Are you a DANTES-funded military examinee?
 Yes  No
14. Exam Date:
/
/
15. Examination for which you are registering:
 American Government
 American Literature
 Analyzing & Interpreting Literature
 Biology
 Business Law, Introductory
 Calculus
 Chemistry
 College Algebra
 College Mathematics
 Educational Psychology, Intro. to
 English Literature
 Financial Accounting
 French Language
 German Language
 History of the U.S. I: Early Colonization
 History of the U.S. II: 1865 to the Present
 Human Growth & Development
 Humanities
 Info. Systems & Computer Applications
 Macroeconomics, Principles of
 Management, Principles of
 Marketing, Principles of
 Microeconomics, Principles of
 Natural Sciences
 Pre-Calculus
 Psychology, Introductory
 Social Sciences & History
 Sociology, Introductory
 Spanish Language
 Western Civilization I
 Western Civilization II
16. Repeating Exams:  Check here if you are repeating this exam. Remember, you must wait six months before
repeating an examination.
Question 17 and 18 are for Edinboro University students only.
17. Are you in a provisional admittance program such as Fresh Start, ESP, USP or CSP?  Yes  No
18. Are you currently enrolled or have you previously received a letter grade for this class?  Yes  No
PLEASE NOTE: You cannot take a CLEP exam and receive credit for a course in which you are currently enrolled
and/or have previously received a letter grade (including, but not limited to, an F, W, AU, or I).
19. Please state how you learned about CLEP exams:
20. Fees: The fee for each CLEP exam is $80 payable to CLEP and $10 payable to Edinboro University. You must pay
the $80 to CLEP on the day of the exam by valid credit card (preferred method of payment), check, or money order.
The $10 fee to Edinboro University will be posted to your student account at the time of registration. If you are not an
Edinboro student, $10 fee to Edinboro University can be paid by check, money order, or cash, and is due at the time
of registration. The $10 fee is non-refundable.
Paying CLEP by:  Credit Card
 Check/Money Order
Check/Money Order#:
Check Holder Name:
NOTE: This is how you will be paying CLEP on the day of the exam and NOT how you are paying Edinboro University at the
time of registration. This information is needed for pre-registration.
21. I understand that the $10 payable to Edinboro University is non-refundable and will be posted to my student account
at the time of registration (Edinboro students) or is due at the time of registration (non-Edinboro students). I also
understand that the registration form is due two weeks prior to the exam date listed in question #14.
Student Signature
Date