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 *DateMay 16th and 17thMay 21st and 22ndMay 23rd and 24thJune 4th and 5thJune 6th and 7thJune 11th and 12thJune 13th and 14thJune 18th and 19thJune 20th and 21stJune 25th and 26thJune 27th and 28thJuly 2nd and 3rdJuly 23rd and 24thJuly 25th and 26thSelect a Tuesday/Wednesday or Thursday/Friday 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 studentMay 16th and 17thMay 21st and 22ndMay 23rd and 24thJune 4th and 5thJune 6th and 7thJune 11th and 12thJune 13th and 14thJune 18th and 19thJune 20th and 21stJune 25th and 26thJune 27th and 28thJuly 2nd and 3rdJuly 23rd and 24thJuly 25th and 26th3rd 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 studentMay 16th and 17thMay 21st and 22ndMay 23rd and 24thJune 4th and 5thJune 6th and 7thJune 11th and 12thJune 13th and 14thJune 18th and 19thJune 20th and 21stJune 25th and 26thJune 27th and 28thJuly 2nd and 3rdJuly 23rd and 24thJuly 25th and 26thTotal *$0.00Payment Confirmation *I hereby authorize ________ to charge my credit card with the amount above.Submit