TOEFL iBT® SCORE REVIEW REQUEST FORM

TOEFL iBT® SCORE REVIEW REQUEST FORM TOEFL iBT ® SCORE REVIEW REQUEST FORM IMPORTANT Your scores cannot be reviewed if you have already requested that they be sent to an institution or agency You can[.]

TOEFL iBT ® SCORE REVIEW REQUEST FORM IMPORTANT: Your scores cannot be reviewed if you have already requested that they be sent to an institution or agency You can request a score review of your TOEFL iBT Writing and/or Speaking section up to 30 days after you take the test.* Visit www.ets.org/toefl/test-takers/ibt/scores/getting/score-review/ for additional information The TOEFL iBT score review requests can be completed online, through your ETS account, at www.ets.org/mytoefl using a credit or debit card Use this form ONLY if you are paying with a paper check or money order Make sure to check the appropriate box below, indicating what test section scores you are requesting to be reviewed for the test date specified Complete the entire form and follow the submission instructions below Speaking and Writing (US$160) Speaking (US$80) Writing (US$80) Test Date: _ Appointment Number: Month Day Year Name: Date of Birth: _ Month Day Year Address (include ZIP or postal code): Check this box if your mailing address has changed since the test date indicated above Print your new address below Address (include ZIP or postal code): * Not available for the TOEFL iBT Paper Edition Copyright © 2022 by ETS All rights reserved ETS, the ETS logo, and TOEFL iBT are registered trademarks of ETS in the United States and other countries All other trademarks are the property of their respective owners CUT HERE SUBMITTING THE TOEFL iBT ® SCORE REVIEW REQUEST FORM DIRECTIONS – Fill in the dollar amount and include value-added or similar taxes where applicable Make remittance payable to ETS-TOEFL DO NOT SEND CASH Fees and terms relating to fees and payments are available at www.ets.org/toefl/test-takers/ibt/take/fees/ TOTAL AMOUNT ENCLOSED $ For all other payment methods, send completed form and payment to: ETS-TOEFL PO Box 382044 Pittsburgh, PA 15251-8044 USA Make check/money order payable to ETS-TOEFL If you are paying by check, you are authorizing ETS at its discretion to use the information on your check to make a one-time electronic debit from your account for the amount of your check; no additional amount will be added Please be aware that your bank account may be debited as soon as the same day we received your payment and you will not receive a canceled check The results of the rescoring process will be available 1–3 weeks after receipt of your Request Form and payment 149786-145830 • UNLWEB422