ACCUPLACER REQUEST
  

   


 

ACCUPLACER Assessment Request Form
   
Full Name at Time of Testing: First Name: Last Name:
Other Names Used While Enrolled: First Name: Last Name:
Street Address:
City: State: Zip Code:
Date of Birth:
 mm/dd/yy		 Student ID#: Last 4 Digits of SSN:
Contact Telephone Number:
 		 (xxx) xxx-xxxx
Official scores are issued to educational institutions or business establishments.
Name of School or Business:
Street Address:
City: State: Zip Code:

Please allow five (5) business days to process all requests.

Fayetteville Technical Community College
P.O. Box 35236
2201 Hull Road
Fayetteville, NC 28303
910.678.8417