Accuplacer Test Unit Request Form

Used for high schools requesting Accuplacer test units

Proctor Name  

School/Site Name  

Company Email Address  

Testing Date Range   no more than 30 days out

Accuplacer Testing Agreement   I agree that Accuplacer testing will only be done for students applying to Dual Credit classes or college admission purposes.

Number of students testing in Math (can be used for any of the Math placements)  

Choose One1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950

Number of students testing in Reading_NG_Dual Credit  

Choose One1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950

Additional Comments

Spam Check

*All requests will be reviewed and we may follow up with additional questions before granting more test units.