Online Distance Testing Registration Form


 Please Note:

   • Complete this registration form only if you intend to pay by credit card, otherwise click here for a printable version.

   • Once we receive your complete registration information, you will receive a confirmation of your scheduled test date.



 1.  Personal Information:

   Last Name First Name Middle Initial
 
   Street Address Apt. City State Zip Code
 
   Day Telephone Ext. Evening Telephone Cellular Phone
 
   Email Address Social Security Number Date of Birth (mm/dd/yy)
 
   Sex Height  Weight Color of Hair Color of Eyes
  Male     Female




 2.  Examinations Information:

   First Choice Test Date Time Second Choice Test Date Time
WPU Service Fee per exam
$30.00

We will contact you to make any necessary arrangements before your test date.

  Examinations for which you are registering:

Exam 1 Check if this is a paper exam
 
Exam 2 Check if this is a paper exam




 3. Additional Information:



  Please indicate additional information, questions, comments below.

Check here if this is a DSST exam.