EMERGENCY WITHDRAWAL WAIVER APPLICATION

Cancellations for EIPA Test registrations must be made a minimum of five (5) full days before the scheduled date and time of the test. Registrants who cancel after the deadline OR who fail to show up at the test site at the designated time will forfeit the entire test fee.

Registrants who cancel after the five-day deadline or who fail to appear at the test site on the day of the test MAY be eligible to receive a coupon code to use toward the registration of another test (*terms and restrictions apply). Emergency Withdrawal Waiver Applications will only be considered if one of the following three circumstances impacted your ability to attend the scheduled test reservation:

1.Illness or medical emergency

2.Auto accident

3.Death in the immediate family

1. Complete the Emergency Withdrawal Waiver Application. THE APPLICATION MUST BE RECEIVED BY THE EIPA DIAGNOSTIC CENTER NO LATER THAN 5 DAYS AFTER THE SCHEDULED TEST DATE! For example, if a test date falls on a Monday, the EIPA Diagnostic Center must receive the application by the following Saturday. A confirmation of receipt will be emailed to the applicant during regular business hours. If a confirmation of receipt email is not received, the applicant is responsible for resending the application and/or contacting EIPA.
2. The required supporting documentation or URL must be submitted with the Emergency Withdrawal Wavier Application. Applications received that do not have the required documentation or URL will not be considered. Refer to the table below for appropriate supporting documentation or URL.

Circumstance	Required Supporting Documentation OR URL (web address)
Illness or medical emergency	Documentation from an appropriate medical professional
Auto accident	Accident report. The report must list the date and time of the accident (to demonstrate the conflict with the test start time) and must include the name of the registrant (even if the registrant is a passenger in the vehicle).
Death in the *immediate family	*The URL of an obituary *Additional documentation may be required to demonstrate the familial relationship. For Example, if your name is not listed among the list of survivors because the deceased is the immediate family of your spouse, you may submit a copy of your marriage license along with the URL of the obituary.

*Immediate family is defined as the registrant’s spouse, parents, spouse’s parents, siblings, children, step-children, grandparent, great-grandparents, grandchildren, aunts, uncles, siblings-in-law, or civil union partners.

The EIPA Diagnostic Center grants Emergency Withdrawal Waivers on a case-by-case basis and at the sole discretion of the EIPA Diagnostic Center staff.

Following a decision by the EIPA Diagnostic Center staff, an email will be sent to the applicant. Please allow 2 weeks from the receipt of the application for the decision. Registrants who are granted an Emergency Withdrawal Waiver are provided a coupon code redeemable on the EIPA Test catalog’s website. The value of the coupon code will be equal to the amount of the registration fee, minus a $40.00 fee. Coupon code restrictions are as follows:

1. The coupon code will expire 6 months after the original test date. No Exceptions.

2. The coupon code must be entered during checkout.

3. The coupon code has no cash value and may not be returned or redeemed for cash.

4. EIPA cannot guarantee the availability of test dates at the original test location. If there are no convenient test dates at the original location, you may have to travel to an alternate location. The EIPA Diagnostic Center and EIPA approved proctors or LTAs are not required to ensure the availability of preferred test dates or preferred test locations before the coupon code expiration date. If necessary, you will need to travel to a different test site.

Submission of the Emergency Withdrawal Waiver Application AND required supporting documentation must be submitted together within 5 days following the scheduled test date. Emergency Withdrawal Waiver Applications received without supporting documentation will not be considered.

*Definition of “immediate family” can be found on previous page.