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