Testing Center Application

Testing Center Application
SECTION 1 — Organization Information
Organization / Business Name:*
Type of Organization:*
Primary Contact Name:*

First NameLast Name
Title / Role:*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Business Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website (if applicable):
SECTION 2 — Testing Facility Details
Testing Location Address (if different):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Facility Type:*
Maximum Number of Candidates You Can Test at One Time:*
YesNo
YesNo (if no, please explain the the comment section)
SECTION 3 — Technology & Equipment Requirements
Internet Speed Available:*
Desktop computersLaptopsTabletsStudents will bring their own device
Number of Devices Available for Testing:
YesNo
YesNo
SECTION 4 — Proctor Information
Designated Lead Proctor Name:*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
If yes, list names:
I understand
SECTION 5 — Exam Administration Details
Which exam(s) do you plan to offer at your site?*
Will students be paying individually or will your organization pay for group seats?*
SECTION 6 — Compliance & Verification
YesNo
YesNo
YesNo
SECTION 7 — Authorization & Signature
By signing below, you affirm that all information provided is accurate and that your organization agrees to comply with all testing center requirements.
Authorized Representative Name:*
Title:*
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Testing Center Application

SECTION 1 — Organization Information

SECTION 2 — Testing Facility Details

SECTION 3 — Technology & Equipment Requirements

SECTION 4 — Proctor Information

SECTION 5 — Exam Administration Details

SECTION 6 — Compliance & Verification

SECTION 7 — Authorization & Signature