Students Professional Achievement Taking Exams Student Scholarship Information Summer School Teachers Accreditation Continuing Education Examination Information and Downloadable Forms Training Tips CCA Teacher Scholarship Information Teacher’s Seminar Examination Financial Sheet and Payment Form Examination Financial Sheet and Payment Form Please use this form to submit financial report and payment for CCA studio exam sessions. Exam Host/ Committee Registrar InformationName* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Phone*Email* Date of Exam Session*LocationMy CCA membership dues are up to date.YesNoStudent Exam FeesExam-Primary I, II, & III Quantity Price: $150.00 Quantity Exam-Grade I Quantity Price: $60.00 Quantity Exam-Grade II Quantity Price: $65.00 Quantity Exam-Grade III Quantity Price: $75.00 Quantity Exam-Grade IV Quantity Price: $85.00 Quantity Exam-Elementary (V) Quantity Price: $115.00 Quantity Exam-Intermediate (VI) Quantity Price: $130.00 Quantity Exam-Advanced (VII) Quantity Price: $150.00 Quantity Exam-Diploma Quantity Price: $250.00 Quantity Additional Exam Fee for Student Exams Grade I-IV with 1-2 Candidates Quantity Price: $25.00 Quantity Teacher Exam FeesExam-Teacher-Grade I Quantity Price: $150.00 Quantity Exam-Teacher-Grade II Quantity Price: $150.00 Quantity Exam-Teacher-Grade III Quantity Price: $175.00 Quantity Exam-Teacher-Grade IV Quantity Price: $200.00 Quantity Exam-Teacher-Elementary (V) Quantity Price: $250.00 Quantity Exam-Teacher-Intermediate (VI) Quantity Price: $350.00 Quantity Exam-Teacher-Advanced (VII) Quantity Price: $450.00 Quantity Exam-Teacher-Diploma Quantity Price: $550.00 Quantity Total Exam Fee: $0.00 Credit Card Billing Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name CAPTCHAEmailThis field is for validation purposes and should be left unchanged. 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