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    Application For A Prelicensing Certificate of Completion in Connecticut

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    Jon Farens
    1. The document provides instructions for obtaining a Prelicensing Certificate of Completion in Connecticut, which includes filling out an application form, studying course materials, passing an exam with a proctor, and submitting required documents. 2. Applicants must fill out personal information on the application form, have their exam proctored by a disinterested third party, and fax or mail everything to ABLE Incorporated to receive their certificate within 2 business days. 3. The affidavit form requires signatures from both the applicant and proctor to verify exam details and attest that the exam was completed without assistance.

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    Application For A Prelicensing Certificate of Completion in Connecticut

    Uploaded by

    Jon Farens
    24 views2 pages
    1. The document provides instructions for obtaining a Prelicensing Certificate of Completion in Connecticut, which includes filling out an application form, studying course materials, passing an exam with a proctor, and submitting required documents. 2. Applicants must fill out personal information on the application form, have their exam proctored by a disinterested third party, and fax or mail everything to ABLE Incorporated to receive their certificate within 2 business days. 3. The affidavit form requires signatures from both the applicant and proctor to verify exam details and attest that the exam was completed without assistance.

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    1. The document provides instructions for obtaining a Prelicensing Certificate of Completion in Connecticut, which includes filling out an application form, studying course materials, passing an exam with a proctor, and submitting required documents. 2. Applicants must fill out personal information on the application form, have their exam proctored by a disinterested third party, and fax or mail everything to ABLE Incorporated to receive their certificate within 2 business days. 3. The affidavit form requires signatures from both the applicant and proctor to verify exam details and attest that the exam was completed without assistance.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    24 views2 pages

    Application For A Prelicensing Certificate of Completion in Connecticut

    Uploaded by

    Jon Farens
    1. The document provides instructions for obtaining a Prelicensing Certificate of Completion in Connecticut, which includes filling out an application form, studying course materials, passing an exam with a proctor, and submitting required documents. 2. Applicants must fill out personal information on the application form, have their exam proctored by a disinterested third party, and fax or mail everything to ABLE Incorporated to receive their certificate within 2 business days. 3. The affidavit form requires signatures from both the applicant and proctor to verify exam details and attest that the exam was completed without assistance.

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    IMPORTANT DOCUMENT - DO NOT DISCARD

    Provider 0244

    You will need to fill out this form in order to receive your certificate.

    Application for a Prelicensing Certificate of Completion in Connecticut


    1. Read the Licensing Information Bulletin located on Prometrics website at www.prometric.com, or call them for a free copy at 800-341-3257. 2. Study each chapter and take chapter quizzes. 3. Use the Simulate Your Exam feature and pass the exam with a score of 70% or higher. Print your score sheet. IMPORTANT: Your exam will need to be monitored by a disinterested third party, which can be anyone except for relatives and coworkers within your division. Both you and your proctor must fill out the proctor affidavit. 4. Fill out your personal information on this form and fax it, along with your score sheet and Affidavit of Exam Completion, to ABLE Incorporated at 866-539-2617. 5. Your Prelicensing Certificate of Completion will be processed in 2 business days. It will then be mailed to you. If you require expedited processing, call 877-441-2378. You will need to take this certificate to the exam and will also need to submit it to the DOI when you apply for your license.
    Please indicate the type of license that you will be obtaining. IMPORTANT: This must match the line of license listed on your score sheet(s). Life only Health only Life & Health combined Property & Casualty combined

    IMPORTANT: Please PRINT legibly. This information

    Name: __________________________________________________________ Phone Number: ___________________________________________________ Residence Street Address: ___________________________________________ City: ____________________________________________________________ State: ___________________________________________________________ Zip: _____________________________________________________________ Social Security Number: ____________________________________________ E-mail: __________________________________________________________ ABLE Incorporated
    111 Oak Street, Bonner Springs, KS 66012 877-441-2378

    Affidavit of Prelicensing Exam Completion


    You and your proctor must complete this form to obtain your prelicensing certificate. DO NOT take this form to the testing center.
    ABLE Incorporated

    IMPORTANT: This form needs to be signed by both you and your proctor on the day that you take the test. We will not accept forms that are incomplete or list different exam and proctor dates. If you have any questions about how to complete this form, please call 877-441-2378. Note that your proctor must be a disinterested third party (someone other than a coworker in your division or relative).
    Address of Prelicensing Exam Location
    Street City Prelicensing Exam Date Proctor Type: Begin Time State AM PM Postal Code End Time AM PM

    Neighbor Acquaintance

    Librarian Coworker (NOT in your division) Computer lab technician Person with no prior relationship (personal, corporate, other)
    Title of Prelicensing Exam Proctor Telephone ( ) Ext.

    Name of Prelicensing Exam Proctor Agency/Company Name Mailing Address City State

    Postal Code

    I certify that I, a disinterested third party, verified the identification of the student as signed below and that I administered said students final examination. I further certify that the exam was completed without external or personal assistance of any type.
    Students Name Course Name

    Signature of Prelicensing Exam Proctor

    Date (must be signed on prelicensing exam date)

    A f f i d a v i t o f P e r so na l R e sp o n s i b i l i t y
    C o m pl et ed and Si gned b y St ud ent I affirm that I personally completed the entire study material of the course. I also affirm that I completed the exam without assistance from any course material, other source material, or from any persons.

    Students Signature

    Date (must be signed on prelicensing exam date)

    ABLE Incorporated 111 Oak Street - Bonner Springs, KS 66012 - 877-441-2378

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