FORMS

 

CLEP Schedule Request Form

PREFERRED EXAM DATE:                                                          2nd CHOICE EXAM DATE:

NAME:

EMAIL:

PHONE NUMBER:

TICKET ID NUMBER:

EXAM NAME:

TICKET EXPIRATION DATE:

IS THIS A DANTES FUNDED EXAM (Please circle one):  YES       NO               

COLLEGE RECEIVING TRANSCRIPTS:

We must receive this form & the $15.00 non-refundable administration fee by the deadline date. 
Checks or money orders must have your name & “CLEP” in the Memo section.
Do NOT send your Exam Registration Ticket but bring it with you on the day of your exam.
If you are in need of accommodations, please schedule in person; bring your Exam Registration Ticket, your receipt from the Business Office, and your documentation from the O'Neill Center.

Mail form and payment to:
Cape Cod Community College/Testing Center
2240 Iyannough Rd., W. Barnstable, MA 02668   ATTN: Chief Examiner of CLEP

 

Application for Off-Site ACCUPLACER® Administration

To have the ACCUPLACER® administered in our Testing Center; at Cape Cod Community College, please have your College fill out and forward this form to Jim McLoughlin at jmcloughlin@capecod.edu.  Once this form has been completed and returned, he will forward a time when we can accommodate you for testing.  If you have any questions, please contact Mr. McLoughlin at 774-330-4454.

STUDENT INFORMATION

STUDENT’S NAME

STUDENT’S ID NUMBER

STUDENT’S EMAIL ADDRESS

STUDENT’S PHONE NUMBER

STAFF MEMBER AND COLLEGE INFORMATION

STAFF MEMBER’S NAME

STAFF MEMBER’S PHONE NUMBER                                                               EXT. #                        

STAFF MEMBER’S EMAIL ADDRESS

NAME OF COLLEGE

VOUCHER INFORMATION (IF VOUCHERS ARE USED)

IF VOUCHERS AREN’T USED, PLEASE FILL IN THE INFORMATION BELOW:

ACCUPLACER USER NAME

ACCUPLACER PASSWORD

BRANCHING PROFILE

SPECIAL INSTRUCTIONS

For Testing Coordinator’s Use Only -  Please do not enter values in the fields below

TEST DATE

TIME