Placement Testing Registration Form

* = required fields.

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 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

Yes No

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None (no disability) Extended Time Reader
Word Processor Multiple Testing Sessions Mobility
Other (Someone will contact you to discuss your needs)
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    You are scheduling for:

    Date: Tuesday, May 14,2013
    Time: 3:00pm