Request to Host a Certification Examination Offering

Please note that this form is for requesting an examination offering. The information you provide in the form will assist us in scheduling the examination. The Registrar will confirm you requested date via e-mail.

Name of individual making request*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

Organization hosting the offering*

Location (City, State) of offering*

Address of the offering*

Building Name

Street Address Line 2

CityState / Province

Postal / Zip Code

Room Name of Offering*

Type UNK if you do not yet know the room assignment.

Please identify the certifications you wish to offer. Please note that all examinations will be electronic EXCEPT for the Drug Analysis which will remain in paper form.*

Biological Evidence Screening (90 minutes)Forensic DNA (2 hours 15 minutes)Foundational Knowledge (2 hours 15 minutes)Seized Drug Analysis (2 hours 15 minutes)Drug Analysis (3 hours)

Based on our facility requirements, what is the maximum number of candidates your facility can accommodate?*

Who will act as the Local Arrangements Coordinator? Please note that the LAC should also act as one of the Monitors*

MeSomeone Else, I will provide contact information below

LAC Name*

First NameLast Name

LAC Email*

example@example.com

LAC Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Upload Completed LAC Instructions and Checklist (available on our website)*

Who will act as the Proctor? If you are the LAC and the Proctor, you will need to find an additional person to act as Monitor if you have more than one candidate.*

MeSomeone Else, I will provide contact information below

Proctor Name*

First NameLast Name

Proctor Email*

example@example.com

Proctor Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Will this be a PUBLIC or PRIVATE offering? A public offering is one where any candidate who has been approved by the Credentials Committee may sit for an examination. A private offering is one where the host organization determines who, out of the candidates approved to sit, may enter their facility and sit for the examination.*

PublicPrivate

Select your date of offering and REGISTRATION time (local time) for your date.*

Do you have additional comments? Please include any facility-specific information such as site access, gate codes, or any other information that the Proctor and/or candidates should be aware of.