Cap Exam Reschedule Form

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CAP Exam Reschedule Form
MAIL THIS FORM WITH PAYMENT TO:
ISA CAP Program
PO Box 12277
Research Triangle Park, NC 27702-2277 USA
FAX THIS FORM TO: +1 919-549-8288
1. Applicant Information (Please print or type.)
Name of Applicant ____________________________________________________________________________________________
Job Title _____________________________________________________________________________________________________
Company Name ______________________________________________________________________________________________
❑ Home
❑ Office
Preferred Mailing Address:
Street Address ________________________________________________________________________________________________
_____________________________________________________________________________________________________________
City__________________________________________________ State/Province __________________________________________
Postal Code___________________________________________ Country _______________________________________________
Telephone (_________) _________________________ Fax (_________) ________________________________________________
Email Address _________________________________________________________________________________________________
2. Examination Information
Reschedule fees:
No fee • Electronic exams rescheduled, within your twelve (12) month eligibility period,
• 48+ hours in advance of exam date in US/Canada
• 5+ days in advance of exam date outside of US/Canada
• Private or special event paper/pencil exams rescheduled, within your twelve (12) month eligibility period, more than
45 days in advance of exam date
135
$
• Electronic exams at any location rescheduled, within your twelve (12) month eligibility period, without proper
advanced notice
• Private or special event paper/pencil exams rescheduled, within your twelve (12) month eligibility period, less than
45 days in advance of exam date
Payment:
❑ American Express
❑ MasterCard
❑ Visa
❑ Discover Card
Account No. ____________________________________________________ Expiration Date _____________________________
Signature ______________________________________________________ Amount to be Charged $ ____________________
OR
❑ Personal Check, Certified Check, or Money Order (Payable to ISA) NOTE: Purchase Orders are not accepted.
Applying for:
❑ Electronic Exam (Candidate will choose an exam date within his or her current twelve-month testing window.)
OR
❑ Private Exam Site
Date _____________________________________ City, State to Test _________________________________________________
(ISA cannot process your retest form without a date and location for private exam sites. If your company has not scheduled a new private exam date, or if you
want to reschedule to a special event exam date, refer to for information on taking the exam.)
Original Test Date ___________________________ City, State________________________________________________________
I understand that my application on file with ISA is true and correct and will apply for this examination date.
Signature _________________________________________________________ Date ______________________________________
36-4199-0115

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