*****  This affidavit has opened in a new window  *****

Take a quick look at this affidavit. If the affidavit requires a beginning and ending time field
leave this window open so the monitor can input the ending time of the exam.

Some affidavits request that you fill out and mail to Broker Educational Sales & Training, Inc.
By clicking the Submit button below the affidavit is being electronically sent to them.

You may want to print this page after filling out all the details as a record for yourself.

 

 

West Virginia

AFFIDAVIT OF PERSONAL RESPONSIBILITY
To be Signed by Student



I declare that I personally completed this exam without any outside assistance including course material, other source material or assistance from any one person(s).

 
Signature
(You can sign this form by typing in your name)
Date


AFFIDAVIT OF EXAM COMPLETION
To be Completed and Signed by Exam Monitor



I declare that I personally observed the above named individual during the completion of this examination and also observed that the student received no outside assistance in completing the examination.

 
Name of Student Name of Course
 

Address where exam was taken

Date exam was taken


MONITOR: DISINTERESTED THIRD PARTY
 

Print name of person administering test Job title of person administering test
Company/agency name Business phone number

Business mailing address

Signature of person administering test
(You can sign this form by typing in your name)
Date

Before clicking Submit below
 
 Affidavit must be filled out completely for credit.
 Any missing information will delay credit to examinee.

If you are printing this affidavit to send to Broker Educational Sales & Training, Inc. then send to:
Broker Educational Sales & Training, Inc.
7137 Congress Street
New Port Richey, FL 34653
or fax to: 727-372-7585
or email to: processing@brokered.net


By pressing the Submit button below you are electronically sending this form to us.