Group Testing Request "*" indicates required fields REQUESTOR INFORMATIONOrganizers Name* First Last Email* Phone*School/Program Name* TEST DETAILSStudent Type* High School Current Mid-South Student Outside Test Date* MM slash DD slash YYYY Start Time* Hours : Minutes AM PM AM/PM Expected End Time Hours : Minutes AM PM AM/PM How many expected for testing?* 5-10 15-20 25-30 Other Type of Exam* Placement (Accuplacer) Certification Classroom Other Requested Testing Location* Have you or will you Collect Fees?* Yes No - I need Mid-South Testing to do this The test does not require fees Are Computers needed for testing?* Yes No No - Computers are NOT needed, but there is other technology needed (Please specify in additional comments) Will you supply the computers* Yes No - I need Mid-South Testing to provide ADDITIONAL COMMENTSAdditional comments, concerns and/or questionsNameThis field is for validation purposes and should be left unchanged.
