Proctored Test Request Form

Please complete the following information:
Items marked with an asterisk (*) are required and your request may not be processed or may be significantly delayed if they are not included.

Student Information:

Full name *

Phone number *

Email address *

School sending the exam*

Exam name *

Special requirements

Which location do you want the exam sent to?*

	Tempe (480-517-8560) 2323 W. 14th Street Tempe, AZ 85281
	PV Mall (480-377-4200) 4550 E. Cactus Road Phoenix, AZ 85032
	East Valley (480-377-4150) 1455 S. Stapley Drive, Ste 15 Mesa, AZ 85024 (just north of the Superstition Freeway)
	Lifelong Learning Center (480-377-4250) 12535 Smokey Drive Surprise, AZ 85374 (just south of Bell Road)
	Avondale (480-377-4400) 420 N. Central Avenue Avondale, AZ 85323
	Luke AFB (480-377-4010) 56th Mission Support Center, Room 3138 7383 N. Litchfield Road Glendale, AZ 85309 (two blocks north of Glendale Avenue on Luke Air Force Base)

I have read the proctoring guidelines * Yes No