Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Cardholder Name *FirstLastPhone NumberPlease enter a phone number that the Proctor will be able to text/call if an issue arises. Email *Please provide an email address to receive your testing resultsCredit Card Details *Number of Students Testing * One Student – $55.00 Two Students – $110.00 Three Students – $165.00 Student Name *FirstLastPlease enter your student’s name. Up to three students Student Date of Birth *Select the test Grade Level *Grade Level3rd Grade Test4th Grade Test5th Grade Test6th Grade Test7th Grade Test8th Grade Test9th Grade Test10th Grade Test11th Grade Test12th Grade TestSelect your testing dates *DateApril 21st and 22ndMay 19th and 20thJune 16th and 17thJuly 14th and 15thJuly 28th and 29thSelect a Tuesday/Wednesday pair of test dates. PLEASE NOTE, there will be a mandatory Practice Test on the Monday of your testing week.2nd Student's Name (if needed)FirstLastStudent Date of Birth (2nd Student)Select the test Grade Level (2nd Student)No 2nd student3rd Grade Test4th Grade Test5th Grade Test6th Grade Test7th Grade Test8th Grade Test9th Grade Test10th Grade Test11th Grade Test12th Grade TestSelect your testing dates (2nd Student)No 2nd studentApril 21st and 22ndMay 19th and 20thJune 16th and 17thJuly 14th and 15thJuly 28th and 29th3rd Student's Name (if needed)FirstLastStudent Date of Birth (3rd Student)Select the test Grade Level (3rd Student)No 3rd student3rd Grade Test4th Grade Test5th Grade Test6th Grade Test7th Grade Test8th Grade Test9th Grade Test10th Grade Test11th Grade Test12th Grade TestSelect your testing dates (3rd Student)No 3rd studentApril 21st and 22ndMay 19th and 20thJune 16th and 17thJuly 14th and 15thJuly 28th and 29thTotal *$0.00Payment Confirmation *I hereby authorize ________ to charge my credit card with the amount above.Submit
