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

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.