Placement Testing Registration Form

* = required fields.

Please enter your M number.

Please enter your first name.

Please enter your last name.

Please enter your phone number with area code. Please enter a valid phone number 000-000-0000.

Please enter your Date of Birth. Please enter a valid date of birth.

Please enter a valid e-mail address, for example
Please call 315-731-5802 for assistance if you do not currently have an email address

I have completed a blue book writing sample. Yes No

Dual Credit College Connection College Bridge None

Please make a selection.

Full Part

Please make a selection.

Yes No

Please make a selection.

Yes No

Please make a selection.

None (no disability) Extended Time Reader
Word Processor Multiple Testing Sessions Mobility
Other (Someone will contact you to discuss your needs)
Please make a selection.

    You are scheduling for:

    Date: Monday, December 10,2012
    Time: 3:00pm