Student Testing Services

Accuplacer Distance Testing Administration Form

Incomplete or Incorrect Requests Will Not be Processed.

If we can't read your handwriting, we can't process your request!



Student Name:            __________________________________

Student Phone Number:                             ____________________

Student SLCC ID Number: S00                 ___________________ _

Student E-mail Address:                                 ___________________________

Name of Institution willing to proctor test:                        ____             ____        

Name and contact information of person at institution:

Name of Contact Person:                                     _________________________

E-mail of Contact Person:                                       ________________________

Phone Number:                                                                      __________________

Fax Number:                                                                _______________________

Date you have scheduled with your proctor for test administration:______________________ (Your access will expire the following Sunday at 7:00 pm.)

NOTE: After you have completed your test, your scores WILL NOT be posted until we receive the completed “Accuplacer Distance Proctor Agreement” from your proctor.

***Form must be received at least 2 business days in advance of proposed testing date.***



***Form must be received at least 2 business days in advance of proposed testing date.***

Weber State University students MUST test at Weber State University


Print form and fax  to:

Fax:  801-957-4750

Or copy and paste into email: