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SAT® Archived Score Report Order Form (valid through July 31, 2012) If you have been out of high school for at least a year, and you have not tested for one or more years, use this form to order archived score reports for the SAT® and the SAT Subject Tests™. ➊ Fill in the information below and on page 2 carefully; incomplete forms will not be processed. ➋ Mail the form and payment to the address on page 2 of this form. Forms submitted without payment will be returned.

Personal Information

(Please print. Incomplete information may result in the cancellation of your request.) Most Recent Test Date:____________ /____________ /__________ Registration #: ________________________________

month day year

Last Name:______________________________________ First Name:___________________________ M.I.: _____ Birth Date: ______ /______ /______

month day year

Sex: F ❑ M ❑

Social Security #:_______________________________________ (optional)

Phone: (________ ) _____________________ High School Graduation Year:_______________________________ Present Street Address:______________________________________________________________________________________________ City:__________________________________________________ State:________________________________________________ Country:_______________________________ ZIP/Postal Code:___________________________________________ Email Address:____________________________________________________________________________________

Personal Information at Time of Last Testing

(Please print information below. If your information has not changed, leave this blank.) Last Name at time of testing:______________________________________________________________________ Street Address at time of testing:__________________________________________________________________ City:__________________________________________________ State:_______________________________________ Country:_______________________________ ZIP/Postal Code: _____________________________________________________

Score Recipients Enter the four-digit code for each college, university or scholarship program to which you wish to send an official SAT score report. A list of codes is provided at collegeboard.org/sat-codes and in The SAT Code List available at your local high school.

❘ ___ ___ ___ ___ ❘ ❘ ___ ___ ___ ___ ❘ ❘ ___ ___ ___ ___ ❘ ❘ ___ ___ ___ ___ ❘ ❘ ___ ___ ___ ___ ❘ ❘ ___ ___ ___ ___ ❘ ❘ ___ ___ ___ ___ ❘ ❘ ___ ___ ___ ___ ❘ Please complete page 2

For official use only. Do not write inside this box.


SAT Archived Score Report Order Form, page 2 We will mail results within five weeks of receiving your request to you and to any score recipients you identify on this form. Optional Rush Service: If you need your results sent more quickly, order “rush reports.” Once your request is received and processed, rush reporting sends your score report within two business days (not counting holidays and weekends) either electronically or by first-class mail, depending on how each institution receives scores. Not all colleges or universities can accept rush reports — check before ordering. The fee for this optional rush service is $30.

Mailing and Payment Information Please complete this section to determine the amount of payment to enclose. Number of score recipients (from page 1): ______________________× $10.50 = score report fee search fee (required with every order)

$ $ 28.00

rush reporting fee = $30 (optional)

$

Total Amount Enclosed

$

I have enclosed payment by: (select one) ❑  Check or money order made payable to The College Board Credit Card: ❑  Visa ❑  MasterCard ❑  American Express ❑ Discover For credit card payments, fill out information below: Credit Card Number: ________________________________ Exp. Date: __________________ /______________________

month

year

Name of Cardholder: _______________________________________________________________________________________ Signature of Cardholder: __________________________________________________________________________________________________________________

(required for credit card payments)

In the unlikely event that your archived scores cannot be located, we will refund your payment minus the minimum $28 search fee.

Mail both pages of this form and your payment to: SAT Program P.O. Box 8057 Mt. Vernon, IL 62864

© 2012 The College Board. College Board, achieve more and SAT are registered trademarks of the College Board. SAT Subject Tests is a trademark owned by the College Board. All other products and services may be registered trademarks of their respective owners. 12b-6237


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