Test Compromise Information Form - ICCB



Illinois Community College Board401 E. Capitol AvenueSpringfield, Illinois 62701(217) 558-5668(217) 558-6700 FaxREQUEST TO ADMINISTER THE GED? TESTS IN ILLINOISRequesting Agency InformationName of Requesting Agency: FORMTEXT ?????Street Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ?????ZIP: FORMTEXT ?????Chief Administrative Officer Name: FORMTEXT ?????Chief Administrative Officer Title: FORMTEXT ?????Chief Administrative Officer Phone Number: FORMTEXT ?????Chief Administrative Officer Email Address: FORMTEXT ?????Agency Website URL: FORMTEXT ?????Please provide a brief description of your organization and why you wish to administer the GED? tests: FORMTEXT ?????Pearson VUE Testing Center Location InformationAre you currently an approved Pearson VUE Testing Site? FORMCHECKBOX Yes (complete the information below) FORMCHECKBOX No, but we’ve begun the application process FORMCHECKBOX No, but we will apply (specify when) FORMTEXT ?????Name of Pearson VUE Testing Center: FORMTEXT ?????Street Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ?????ZIP: FORMTEXT ?????In what COUNTY is the testing center located? FORMTEXT ?????Pearson VUE Testing Site Number: FORMTEXT ?????Primary Test Administrator Name: FORMTEXT ?????Primary Test Administrator Phone Number: FORMTEXT ?????Primary Test Administrator Email Address: FORMTEXT ?????Send completed form to ilhseiccb@iccb.state.il.us or fax to 217-558-6700. ................
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