PSAT
Wednesday, October 14, 2015
9:00 a.m. – Test begins
12:45 p.m. – Approximate end of testing
Students should arrive by 8:45 a.m. – Testing location at the high school will be provided by the
school counseling office.
9th, 10th and 11th grade students who are legal residents of Loudoun County but are not enrolled in Loudoun
County Public Schools (LCPS) may participate in PSAT examinations administered by the School Counseling
Departments in LCPS, by following the required registration process.
Testing location is dependent upon your address and the LCPS high school that is in your attendance zone. Testing
at high schools outside your attendance zone is not permitted. Proof of address will be required at time of
registration. (See Registration Form for acceptable documents).
Information for Loudoun County Home or Private Schooled Students:
 To register, complete and submit the registration form which may be obtained from the School
Counseling Office of the LCPS high school in your attendance zone or from the LCPS website at
www.lcps.org by September 18, 2015.
 Test Scores will be mailed to the student’s home address by the College Board by mid-December.
 Test booklets can be picked up from the school counseling office in mid-December.
 Test takers should use their school’s CEEB code, not the CEEB code of the school where they are taking
the test.
o Home schooled students use CEEB code 994-799 for VA Homeschool and their home address on
PSAT answer sheet.
o Private school students use the CEEB code and private school address on the PSAT answer sheet
for the school they attend.
What to bring:
 Identification which includes home address (photo ID preferred)
 Two sharpened No. 2 pencils with erasers
 Calculator – only four-function, scientific, or graphing calculators may be used-check Student Bulletin
 Student’s school CEEB code, or if Home Schooled use 994-799
 Social security number (optional)
 E-mail address (optional)
Cautions:
 Only one five-minute stretch break and one one-minute break are permitted.
 Use of following is prohibited: cellular phones; pagers; electronic devices; watch alarms; protractors;
compasses; rulers; dictionaries or other books; pamphlets; papers of any kind; highlighters; colored
pencils or pens; listening, recording, copying, or photographic devices; or any other aid.
 No food or beverage allowed in the testing room.
 No talking permitted in the testing area.
 No visitors or parents allowed in the testing room.
 Latecomers cannot be admitted per College Board policy.
PSAT Registration for Wednesday, October 14, 2015
Please Print
Return this completed form to the School Counseling Office per your attendance zone by September 18, 2015
Student Name: Click here to enter text.
DOB: Click here to enter text.
Parent/Guardian Name: Click here to enter text.
Student Address*: Click here to enter text.
*Acceptable Documents for Proof of Residency - For Parents/Guardians Residing in Loudoun County - A signed
lease, signed deed, signed settlement papers, recent mortgage statement, or deed of trust. If the parent/guardian
enrolling the student is sharing a home with another resident of Loudoun County, · The "Shared Housing
Documentation" form must be completed and notarized · The parent/guardian must obtain the signature of the
person who owns or rents the residence and · The owner/tenant must provide proof of residency by submitting a
signed lease, signed deed, signed settlement papers, recent mortgage statement, or deed of trust o In addition, the
enrolling parent/guardian may be asked to produce one of the following documents to verify the address: motor
vehicle registration, voter registration card, bank statement (not checks) within the past two months, state or federal
income tax records, W-2 form, or utility bills within the past two months.
Telephone Number: Click here to enter text. E-mail: Click here to enter text.
Current Grade Level: Click here to enter text.
School student currently attends: Click here to enter text.
(write “Home” if home schooled). If student attends a private school, please include the address.
In accordance with College Board regulations, accommodations for special needs will be permitted only if the student
has completed the required “Services for Students with Disabilities Eligibility Form” through College Board for testing
accommodations and provide a copy from SSD of approved accommodations.
Has the student completed a Services for Students with Disabilities Eligibility Form through College Board
for testing accommodations? Check one: ☐Yes ☐No
If yes, please attach the form to this registration sheet.
I wish to register for the October 14, 2015 PSAT at Click here to enter text. and I am
(name of high school per your attendance zone)
aware that I should report to the school no later than 8:45 a.m. School will inform me of location.
Student Signature
Date
I wish to register my child for the October 14, 2015 PSAT at Click here to enter text..
(name of high school per your attendance zone.)
Parent Signature
Date