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Accuplacer Distance Location Form

Request to Take Accuplacer at a Remote Location

         

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Attachment B

Request to Take ACCUPLACER® at a Remote Location

 

Student’s Name: __________________________________________________

Student ID#: __________________________________________________

Student Date of Birth: ___________________________________________

Address:_________________________________________________________

City, State, Zip: ______________________, ______ __________________

E-mail: _________________________________________________

Phone # : (______) ______ - _________

Please fill out the above form and return to:

Bob Watson
Assessment Testing Supervisor
(505) 224-4000 ext. 52015                                              

Fax: (505)224-3258

Email: jwatson40@cnm.edu