State OF NEW Mexico: Lp-Gas Examinations Candidate Information Bulletin
State OF NEW Mexico: Lp-Gas Examinations Candidate Information Bulletin
3210 E Tropicana
Las Vegas, NV 89121
www.psiexams.com
LP-GAS EXAMINATIONS
CANDIDATE INFORMATION BULLETIN
Please refer to our website to check for the most updated information at www.psiexams.com
The Examination Registration Form is found at the end of this TELEPHONE REGISTRATION
Candidate Information Bulletin. You must pay at the time you
register. Be sure the registration form is complete, accurate, For telephone registration, you will need a valid credit card
signed, and that you include the correct fee. The registration (VISA, MasterCard, American Express or Discover).
form is valid for 1 examination. 1. Complete the Examination Registration Form, including
your credit card number and expiration date, so that you
Once you have passed the examination, your passing score is will be prepared with all of the information needed to
valid for one year. register by telephone.
Fees are listed on the registration form found at the end of 2. PSI registrars are available at (800) 733-9267, Monday
this Candidate Information Bulletin. through Friday between 5:30 am and 8:00 pm, and
Saturday-Sunday between 7:00 am and 3:30 pm, Mountain
INTERNET REGISTRATION Time, to receive the information listed on your
Examination Registration Form and to schedule your
For the fastest and most convenient test scheduling process, appointment for the examination.
PSI recommends that candidates register for their
examinations using the Internet. To register over the Internet, PSI will make every effort to schedule the examination site and
candidates will need a valid credit card (VISA, MasterCard, time that is most convenient for you. If space is available in
American Express or Discover). the examination site of your choice, you may schedule an
examination 1 day prior to the examination date of your choice,
Candidates register online by accessing PSI’s registration up to 5:00 pm Mountain Time. Please be prepared to accept
website at www.psiexams.com. Internet registration is alternate examination appointment choices.
available 24 hours a day. To register by Internet, complete
the steps as follows: CANCELING AN EXAMINATION APPOINTMENT
1. Complete the registration form on line and send it to PSI You may cancel and reschedule an examination appointment
via the Internet. without forfeiting your fee if your cancellation notice is
received 2 days before the scheduled examination date. For
2. Upon completion of the online registration form, you will example, for a Monday appointment, the cancellation notice
be given the available examination dates and locations for would need to be received on the previous Saturday. You may
scheduling your examination. Select your desired testing call PSI at (800) 733-9267 or use the PSI Website.
date.
Note: A voicemail message is NOT an acceptable form of
FAX REGISTRATION cancellation. Please use the PSI Website or call PSI to speak
directly to a Customer Service Representative.
For fax registration, you will need a valid credit card (VISA,
MasterCard, American Express or Discover).
1. Complete the Examination Registration Form, including
your credit card number and expiration date.
2. Fax the completed form to PSI (702) 932-2666. Fax
registrations are accepted 24 hours a day.
Please allow 4 business days to process your registration. After
4 business days, you may call PSI to schedule the examination
at (800) 733-9267.
WWW.PSIEXAMS.COM 2
MISSED APPOINTMENT OR LATE CANCELLATION Santa Fe
4001 Office Court Drive, Suite 301
Your registration will be invalid, you will not be able to take Santa Fe, NM 87507
From Albuquerque International Sunport Airport: Head East on Sunport
the examination as scheduled, and you will forfeit your
Blvd SE. Merge onto I-25 N via the ramp to I-40/Downtown and Santa
examination fee, if you: Fe. Take exit 278 and merge onto Cerrillos Road/NM-14 N.
Approximately 2.5 miles north on Cerrillos Road, turn right on Wagon
▪ Do not cancel your appointment at least 2 days before the Road. Turn right on Office Court Drive into the office park.
schedule examination date;
▪ Do not appear for your examination appointment; From Espanola, NM and North Cities: Head Southeast on East Paseo De
▪ Arrive after examination start time; or Onate/US-285S/US-84S (toward Calle Espinosa). Continue on Sandia
▪ Do not present proper identification when you arrive for Drive. Slight right at South Riverside Drive/US-285S/US-84S. Turn
right on Cerrillos Road. Approximately 5 miles on Cerrillos Road, turn
the examination.
left on Wagon Road. Turn right on Office Court Drive into the office
park.
EXAM ACCOMMODATIONS
Colorado Examination Site
All examination centers are equipped to provide access in The following site will offer the New Mexico examinations.
accordance with the Americans with Disabilities Act (ADA) of
1990, and exam accommodations will be made in meeting a Durango
candidate’s needs. Applicants with disabilities or those who 799 East 3rd Street, Suite 3
would otherwise have difficulty taking the examination must Durango, CO 81301
fill out the form at the end of this Candidate Information From Hwy 550: Turn East on College Drive. Go straight then turn right
on East 8th Avenue. Follow until East 3rd Street. PSI Testing Site is on
Bulletin and fax it to PSI (702) 932-2666.
the right in Suite 3.
WWW.PSIEXAMS.COM 3
Additionally, PSI has examination centers in many other ▪ No smoking, eating, or drinking is allowed in the
regions across the United States. You may take this examination center.
examination at any of these locations by filling out the Out-of- ▪ During the check in process, all candidates will be asked if
State Testing Request form found at the end of this Candidate they possess any prohibited items. Candidates may also be
Information Bulletin. asked to empty their pockets and turn them out for the
proctor to ensure they are empty. The proctor may also ask
candidates to lift up the ends of their sleeves and the
REPORTING TO THE EXAMINATION SITE bottoms of their pant legs to ensure that notes or recording
devices are not being hidden there.
▪ Proctors will also carefully inspect eyeglass frames, tie
On the day of the examination, you should arrive at least 30
tacks, or any other apparel that could be used to harbor a
minutes before your appointment. This extra time is for sign-
recording device. Proctors will ask to inspect any such
in, identification, and familiarizing you with the examination
items in candidates’ pockets.
process. If you arrive late, you may not be admitted to the
▪ If prohibited items are found during check-in, candidates
examination site and you will forfeit your examination
shall put them in the provided secure storage or return
registration fee.
these items to their vehicle. PSI will not be responsible for
REQUIRED IDENTIFICATION AT EXAMINATION SITE the security of any personal belongings or prohibited items.
▪ Any candidate possessing prohibited items in the
You must provide 2 forms of identification. One must be a examination room shall immediately have his or her test
VALID form of government issued identification (driver’s results invalidated, and PSI shall notify the examination
license, state ID, passport, military ID), which bears your sponsor of the occurrence.
signature and has your photograph or a complete physical ▪ Any candidate seen giving or receiving assistance on an
description. The second ID must have your signature and examination, found with unauthorized materials, or who
preprinted legal name. All identification provided must match violates any security regulations will be asked to surrender
the name on the Eligibility Letter. all examination materials and to leave the examination
center. All such instances will be reported to the
If you cannot provide the required identification, you must call examination sponsor.
(800) 733-9267 at least 3 weeks prior to your scheduled ▪ Copying or communicating examination content is violation
appointment to arrange a way to meet this security of a candidate’s contract with PSI, and federal and state
requirement. Failure to provide all of the required law. Either may result in the disqualification of
identification at the time of the examination without examination results and may lead to legal action.
notifying PSI is considered a missed appointment, and you will ▪ Once candidates have been seated and the examination
not be able to take the examination. begins, they may leave the examination room only to use
the restroom, and only after obtaining permission from the
SECURITY PROCEDURES proctor. Candidate will not receive extra time to complete
The following security procedures will apply during the the examination.
examination:
▪ Candidates may take only approved items into the
examination room.
▪ All personal belongings of candidates, with the exception TAKING THE EXAMINATION BY
of close-fitting jackets or sweatshirts, should be placed in
the secure storage provided at each site prior to entering
COMPUTER
the examination room. Personal belongings include, but
are not limited to, the following items: The examination will be administered via computer. You will
- Electronic devices of any type, including cellular / be using a mouse and computer keyboard.
mobile phones, recording devices, electronic
watches, cameras, pagers, laptop computers, tablet IDENTIFICATION SCREEN
computers (e.g., iPads), music players (e.g., iPods), You will be directed to a semiprivate testing station to take the
smart watches, radios, or electronic games. examination. When you are seated at the testing station, you
- Bulky or loose clothing or coats that could be used will be prompted to confirm your name, identification number,
to conceal recording devices or notes, including and the examination for which you are registered.
coats, shawls, hooded clothing, heavy jackets, or
overcoats.
- Hats or headgear not worn for religious reasons or TUTORIAL
as religious apparel, including hats, baseball caps, or
Before you start your examination, an introductory tutorial is
visors.
provided on the computer screen. The time you spend on this
- Other personal items, including purses, notebooks, tutorial, up to 15 minutes, DOES NOT count as part of your
reference or reading material, briefcases, backpacks,
examination time. Sample questions are included following the
wallets, pens, pencils, other writing devices, food,
tutorial so that you may practice answering questions, and
drinks, and good luck items.
reviewing your answers.
▪ Person(s) accompanying an examination candidate may
not wait in the examination center, inside the building or
on the building's property. This applies to guests of any The “Function Bar” at the top of the test question screen
nature, including drivers, children, friends, family, provides mouse-click access to the features available while
colleagues or instructors. taking the examination.
WWW.PSIEXAMS.COM 4
SCORE REPORTING
IMPORTANT: After you have entered your responses, you will DUPLICATE SCORE REPORTS
later be able to return to any question(s) and change your
response, provided the examination time has not run out. You may request a duplicate score report after your
examination by emailing scorereport@psionline.com or by
calling 800-733-9267.
EXPERIMENTAL QUESTIONS
WWW.PSIEXAMS.COM 5
The following reference materials are allowed in the
EXAMINATION REFERENCE MATERIAL examination center:
AND CONTENT OUTLINE ▪ NFPA 54 – National Fuel Gas Code, 2012, National Fire
Protection Association (NFPA), (800) 344-3555,
If a test question answer could differ because of conflicting www.nfpa.org (The 2012 and 2015 code can be used between
information in test reference sources, a legal requirement 10/9/2018 and 1/9/2019. After 1/9/2019 only the 2015 code can
such as code, law, or regulation overrides any other reference. be used.)
If two legal requirements appear to conflict, the state-specific ▪ NFPA 58 - Liquefied Petroleum Gas Code, 2017 Edition,
code, law, or regulation overrides the national one. National Fire Protection Association (NFPA), (800) 344-
Information from sources on the test reference list override 3555, www.nfpa.org
information from other sources or persons. ▪ NFPA 1192, Standard on Recreational Vehicles, 2011
Edition, National Fire Protection Association (NFPA), (800)
Many of the reference materials listed are available for 344-3555, www.nfpa.org
purchase at www.psionlinestore.com or by calling the PSI ▪ New Mexico Liquified Petroleum Gas Standard - NMAC
Online Store, toll-free, at (866) 589-3088. 19.15.40, 2006, New Mexico Commission of Public Records,
(505) 476-7900, www.nmcpr.state.nm.us/NMAC
Titles currently in stock are listed on the order form near
the end of this candidate information bulletin. Candidates are responsible for bringing their own references to
the examination center. Reference materials must be bound,
and may be highlighted, underlined, and/or indexed prior to
the examination session. Reference materials containing any
writing will not be allowed into the examination. References
LP Gas Inspector Certification may not be written in during the examination session. Any
candidate caught writing in the references during the
% Required to examination will have the references confiscated and will be
# of Questions Time Allowed
Pass reported to the department. Furthermore, candidates are not
60 75% (45 points) 195 Minutes permitted to bring in any additional papers (loose or attached)
with their approved references. Any additional materials will
CONTENT OUTLINE be removed from the references and confiscated. References
may be tabbed/indexed with permanent tabs only. Temporary
# of tabs, such as Post-It notes, are not allowed and must be
Subject Area removed from the reference before the examination begins.
Items
Combustion Air 2
Venting 2
Pipe, Fittings, Regulators, and Installation 4 CNG-1 CNG Carburetion Sale, Service and Installation
Gas pipe sizing - high pressure 2
Gas pipe sizing - low pressure 2 % Required to
# of Questions Time Allowed
Appliance Installation 3 Pass
Mobile Homes & Recreational Vehicles 4 30 75% (23 points) 60 Minutes
Bulk Plant & Industrial LP Gas Systems 8
Properties of LP Gas / General Info 5 CONTENT OUTLINE
Storage of Cyl's For Use, Resale, or Exchange 2
Vehicular Transportation of LP Gas/Cargo # of
4 Subject Area
Vehicles Items
Engine Fuel Systems 6 Containers 7
Containers/Appurtenances 11 Hose, Pipe, and Fittings 7
Liquid Transfer 5 Carburetion 7
Testing and Inspection 5
REFERENCE LIST Labeling 4
The reference materials listed below were used to prepare the REFERENCE LIST
questions for this examination. The examination may also
contain questions based on trade knowledge or general The reference materials listed below were used to prepare the
industry practices. Except for Code books, you can base your questions for this examination. The examination may also
answers on later editions of references as they become contain questions based on trade knowledge or general industry
available. For Code questions, the examinations will be based practices. Except for Code books, you can base your answers
only on the edition of the Code book that is listed. on later editions of references as they become available. For
Code questions, the examinations will be based only on the
Candidates may use a silent, non-printing, non-programmable edition of the Code book that is listed.
calculator in the examination center.
Candidates may use a silent, non-printing, non-programmable
This examination is OPEN BOOK. calculator in the examination center.
WWW.PSIEXAMS.COM 6
The following reference materials are allowed in the Candidates are responsible for bringing their own references to
examination center: the examination center. Reference materials must be bound,
and may be highlighted, underlined, and/or indexed prior to
▪ NFPA 52 - Vehicular Fuel Systems Code, 2010 Edition, the examination session. Reference materials containing any
National Fire Protection Association (NFPA), (800) 344- writing will not be allowed into the examination. References
3555, www.nfpa.org may not be written in during the examination session. Any
candidate caught writing in the references during the
Candidates are responsible for bringing their own references to examination will have the references confiscated and will be
the examination center. Reference materials must be bound, reported to the department. Furthermore, candidates are not
and may be highlighted, underlined, and/or indexed prior to permitted to bring in any additional papers (loose or attached)
the examination session. Reference materials containing any with their approved references. Any additional materials will
writing will not be allowed into the examination. References be removed from the references and confiscated. References
may not be written in during the examination session. Any may be tabbed/indexed with permanent tabs only. Temporary
candidate caught writing in the references during the tabs, such as Post-It notes, are not allowed and must be
examination will have the references confiscated and will be removed from the reference before the examination begins.
reported to the department. Furthermore, candidates are not
permitted to bring in any additional papers (loose or attached)
with their approved references. Any additional materials will LP-3S Retail Sale of LP Gas
be removed from the references and confiscated. References
may be tabbed/indexed with permanent tabs only. Temporary
% Required to
tabs, such as Post-It notes, are not allowed and must be # of Questions Time Allowed
Pass
removed from the reference before the examination begins.
60 75% (45 points) 155 Minutes
CONTENT OUTLINE
LP-1 Wholesale Sale or Delivery of LP-Gas
# of
% Required to Subject Area
# of Questions Time Allowed Items
Pass ASME Containers 10
40 75% (30 points) 90 Minutes Bulk Delivery 12
DOT Containers 10
Effective 9/1/2017 the time allowed will be 90 Minutes.
Cargo Tank Vehicles 10
This is due to a decrease in experimental questions.
Properties 4
Testing and Inspections 9
CONTENT OUTLINE Regulators 5
# of REFERENCE LIST
Subject Area
Items
Properties 4 The reference materials listed below were used to prepare the
Containers 4 questions for this examination. The examination may also
Point of Transfer 5 contain questions based on trade knowledge or general industry
Vehicular Transportation 11 practices. Except for Code books, you can base your answers
Pipe, Hose and Fittings 6 on later editions of references as they become available. For
Safety Requirements 10 Code questions, the examinations will be based only on the
edition of the Code book that is listed.
REFERENCE LIST
Candidates may use a silent, non-printing, non-programmable
The reference materials listed below were used to prepare the calculator in the examination center.
questions for this examination. The examination may also
contain questions based on trade knowledge or general This examination is OPEN BOOK.
industry practices. Except for Code books, you can base your
answers on later editions of references as they become The following reference materials are allowed in the
available. For Code questions, the examinations will be based examination center:
only on the edition of the Code book that is listed.
▪ NFPA 54 – National Fuel Gas Code, 2012, National Fire
Candidates may use a silent, non-printing, non-programmable Protection Association (NFPA), (800) 344-3555,
calculator in the examination center. www.nfpa.org (The 2012 and 2015 code can be used between
10/9/2018 and 1/9/2019. After 1/9/2019 only the 2015 code can
This examination is OPEN BOOK. be used.)
▪ NFPA 58 - Liquefied Petroleum Gas Code, 2017 Edition,
The following reference materials are allowed in the National Fire Protection Association (NFPA), (800) 344-
examination center: 3555, www.nfpa.org
▪ NFPA 58 - Liquefied Petroleum Gas Code, 2017 Edition, ▪ New Mexico Liquified Petroleum Gas Standard - NMAC
National Fire Protection Association (NFPA), (800) 344- 19.15.40, 2006, New Mexico Commission of Public Records,
3555, www.nfpa.org (505) 476-7900, www.nmcpr.state.nm.us/NMAC
WWW.PSIEXAMS.COM 7
Candidates are responsible for bringing their own references to ▪ New Mexico Liquified Petroleum Gas Standard - NMAC
the examination center. Reference materials must be bound, 19.15.40, 2006, New Mexico Commission of Public Records,
and may be highlighted, underlined, and/or indexed prior to (505) 476-7900, www.nmcpr.state.nm.us/NMAC
the examination session. Reference materials containing any
writing will not be allowed into the examination. References Candidates are responsible for bringing their own references to
may not be written in during the examination session. Any the examination center. Reference materials must be bound,
candidate caught writing in the references during the and may be highlighted, underlined, and/or indexed prior to
examination will have the references confiscated and will be the examination session. Reference materials containing any
reported to the department. Furthermore, candidates are not writing will not be allowed into the examination. References
permitted to bring in any additional papers (loose or attached) may not be written in during the examination session. Any
with their approved references. Any additional materials will candidate caught writing in the references during the
be removed from the references and confiscated. References examination will have the references confiscated and will be
may be tabbed/indexed with permanent tabs only. Temporary reported to the department. Furthermore, candidates are not
tabs, such as Post-It notes, are not allowed and must be permitted to bring in any additional papers (loose or attached)
removed from the reference before the examination begins. with their approved references. Any additional materials will
be removed from the references and confiscated. References
may be tabbed/indexed with permanent tabs only. Temporary
LP-5 Installation, Service and Repair tabs, such as Post-It notes, are not allowed and must be
removed from the reference before the examination begins.
% Required to
# of Questions Time Allowed
Pass
65 75% (49 points) 150 Minutes LP-6 Installation, Service and Repair of Mobile Units
WWW.PSIEXAMS.COM 8
▪ NFPA 1192 - Standard on Recreational Vehicles, 2011 Candidates are responsible for bringing their own references to
Edition, National Fire Protection Association (NFPA), (800) the examination center. Reference materials must be bound,
344-3555, www.nfpa.org and may be highlighted, underlined, and/or indexed prior to
▪ New Mexico Liquified Petroleum Gas Standard - NMAC the examination session. Reference materials containing any
19.15.40, 2006, New Mexico Commission of Public writing will not be allowed into the examination. References
Records, (505) 476-7900, www.nmcpr.state.nm.us/NMAC may not be written in during the examination session. Any
candidate caught writing in the references during the
Candidates are responsible for bringing their own references to examination will have the references confiscated and will be
the examination center. Reference materials must be bound, reported to the department. Furthermore, candidates are not
and may be highlighted, underlined, and/or indexed prior to permitted to bring in any additional papers (loose or attached)
the examination session. Reference materials containing any with their approved references. Any additional materials will
writing will not be allowed into the examination. References be removed from the references and confiscated. References
may not be written in during the examination session. Any may be tabbed/indexed with permanent tabs only. Temporary
candidate caught writing in the references during the tabs, such as Post-It notes, are not allowed and must be
examination will have the references confiscated and will be removed from the reference before the examination begins.
reported to the department. Furthermore, candidates are not
permitted to bring in any additional papers (loose or attached)
with their approved references. Any additional materials will LP-9 Station for Dispensing LP-Gas
be removed from the references and confiscated. References
may be tabbed/indexed with permanent tabs only. Temporary
% Required to
tabs, such as Post-It notes, are not allowed and must be # of Questions Time Allowed
Pass
removed from the reference before the examination begins.
30 75% (23 points) 60 Minutes
CONTENT OUTLINE
LP-8 Installation, Service and Repair of Cylinder
Exchange Cabinets
# of
Subject Area
Items
% Required to
# of Questions Time Allowed Filling 14
Pass
Containers and Transporting 7
30 75% (23 points) 60 Minutes
Safety/Safety Devices 5
Properties 4
CONTENT OUTLINE
# of REFERENCE LIST
Subject Area
Items
Containers and Transporting 10 The reference materials listed below were used to prepare the
Storage 9 questions for this examination. The examination may also
Safety 2 contain questions based on trade knowledge or general industry
Installation 9 practices. Except for Code books, you can base your answers
on later editions of references as they become available. For
Code questions, the examinations will be based only on the
REFERENCE LIST
edition of the Code book that is listed.
The reference materials listed below were used to prepare the Candidates may use a silent, non-printing, non-programmable
questions for this examination. The examination may also calculator in the examination center.
contain questions based on trade knowledge or general
industry practices. Except for Code books, you can base your This examination is OPEN BOOK.
answers on later editions of references as they become The following reference materials are allowed in the
available. For Code questions, the examinations will be based examination center:
only on the edition of the Code book that is listed. ▪ NFPA 58 - Liquefied Petroleum Gas Code, 2017 Edition,
Candidates may use a silent, non-printing, non-programmable National Fire Protection Association (NFPA), (800) 344-
calculator in the examination center. 3555, www.nfpa.org
This examination is OPEN BOOK. Candidates are responsible for bringing their own references to
the examination center. Reference materials must be bound,
The following reference materials are allowed in the and may be highlighted, underlined, and/or indexed prior to
examination center: the examination session. Reference materials containing any
▪ NFPA 58 - Liquefied Petroleum Gas Code, 2017 Edition, writing will not be allowed into the examination. References
National Fire Protection Association (NFPA), (800) 344- may not be written in during the examination session. Any
3555, www.nfpa.org candidate caught writing in the references during the
▪ New Mexico Liquified Petroleum Gas Standard – NMAC examination will have the references confiscated and will be
19.15.40, 2006 with 2009 and 2012 amendments, New reported to the department. Furthermore, candidates are not
Mexico Commission of Public Records, (505) 476-7900, permitted to bring in any additional papers (loose or attached)
http://www.nmcpr.state.nm.us/nmac/parts/title19/19.0 with their approved references. Any additional materials will
15.0040.htm be removed from the references and confiscated. References
may be tabbed/indexed with permanent tabs only. Temporary
WWW.PSIEXAMS.COM 9
tabs, such as Post-It notes, are not allowed and must be
removed from the reference before the examination begins.
% Required to
# of Questions Time Allowed
Pass
35 75% (27 points) 95 Minutes
CONTENT OUTLINE
# of
Subject Area
Items
Carburetion 5
Containers 10
Forklifts 4
Labeling 3
Pipe, Hose, and Fittings 6
Testing and Inspection 4
Portable/Stationary Equipment 3
REFERENCE LIST
WWW.PSIEXAMS.COM 10
NEW MEXICO LP-GAS
EXAMINATION REGISTRATION FORM
3. Mailing Address:
Number, Street Apt/Ste
-
City State Zip Code
5. Email: ____________________________________________@________________________________________
6. Examinations: The fee is for each examination, whether you are taking the examination for the first time or repeating.
Code Examination Name Fee
LP-1 Wholesale Sale or Delivery of LP-Gas $26.91
LP-3S Retail Sale of LP-Gas $48.43
LP-4 Limited Installation, Service and Repair $48.43
LP-5 Installation, Services and Repair $48.43
LP-6 Installation, Services and Repair of Mobile Units $48.43
LP-8 Installation, Service and Repair of Cylinder Exchange Cabinets $26.91
LP-9 Station for Dispensing LP-Gas $26.91
LP-10 LP-Gas Carburetion Sales, Service and Installation, including Repair $26.91
CNG-1 CNG Carburetion Sale, Service and Installation $26.91
LP Gas Inspector Certification $68.88
NOTE: REGISTRATION FEES ARE NOT REFUNDABLE OR TRANSFERABLE
7. Total Fee $___________. You may pay by credit card, money order, company check or cashier’s check. Make check or money
order made payable to PSI. Cash and personal checks are not accepted.
If paying by credit card, check one: VISA MasterCard American Express Discover
9. Affidavit: I certify that the information provided on this registration form (and/or telephonically to PSI) is correct. I
understand that any falsification of information may result in denial of licensure. I have read and understand the
examination information bulletin.
Signature: ___________________________________________________ Date: _____________________________________
Complete and forward this registration form with the applicable examination fee to:
PSI
2820 Broadbent Pkwy NE
Suites E & F
Albuquerque, NM 87107
Phone: 877-663-9267
PSI may occasionally share your information with partners who have offers of interest to you. Please check this box if you do not wish PSI to share
your information with these parties. Please note: PSI will never release your ID number or SSN number.
PSI ONLINE STORE
To place an order for one or more of the following items listed, you may:
All examination centers are equipped to provide access in accordance with the Americans with Disabilities Act (ADA) of 1990.
Applicants with disabilities or those who would otherwise have difficulty taking the examination may request exam
accommodations.
Candidates who wish to request exam accommodations because of a disability should fax this form and supporting documentation
to PSI at (702) 932-2666.
You are required to submit documentation from the medical authority or learning institution that rendered a diagnosis.
Verification must be submitted to PSI on the letterhead stationery of the authority or specialist and include the following:
Address: _________________________________________________________________________________________________
Street City, State, Zip Code
Check any exam accommodations you require (requests must concur with documentation submitted):
Complete and fax this form, along with supporting documentation, to (702) 932-2666 or email it to
examaccommodations@psionline.com.
After 4 days, PSI Exam Accommodations will email you confirmation of approval with instructions for the next
step.