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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.

 

 

CONNECTICUT
AFFIDAVIT OF PERSONAL RESPONSIBILITY
To be Signed by Student

I affirm that I personally completed the entire study material of the course. I also affirm that I completed the exam without assistance from any course material, other source material, or from any person
 

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 certify that I verified the identification of the student. In addition, I administered the final examination and certify that it was sealed until administration and completed without assistance or outside help of any kind.
 

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 administrating 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 clicking Submit below you are submitting this form electronically to Broker Educational Sales & Training, Inc..