LTA Site Information Form

Name of LTA Site:*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Additional information to add:

Below is the information for the main contact person for the Local Testing Administrator (LTA) who would be the contact person to schedule exam time, answer any questions the candidate(s) may have and be the person that CASLI corresponds with regarding the site and any other issues as they arise. If there will be two people for this – please add this information for additional contacts in the note box below.

LTA Main Contact Person*

First NameLast Name

LTA Main Contact Email*

example@example.com

Phone Number*

Area CodePhone Number

Additional Notes on LTA Main Contact

If more than one contact person, please add additional contact person information above.

Proctors/ Test Administrator - they will be the one that support in administering the test on the day of the exam. (Information below will NOT be made public as this is only for CASLI and the LTA). If you plan to be one of the proctor/test administrators, please do add that information below.

Test Administrator / Proctor Information *

	Name	Email	Cell/Mobile Number
Test Administrator / Proctor
Test Administrator / Proctor
Test Administrator / Proctor
Test Administrator / Proctor
Test Administrator / Proctor
Test Administrator / Proctor