Wufoo

Student Information
Name * First Last
NECC ID # (if applicable):
Email *
Date of Birth * MM / DD / YYYY
Phone Number * ### - ### - ####
Institution Information
Name of Institution testing for: *

Enter the name of the institution that you are taking the test for and will be attending.
Institution testing for contact person: * First Last
Institution testing for contact phone number: * ### - ### - ####
Institution testing for contact email: *
Payment Information

Payment of non-refundable $25.00 fee for Accuplacer Remote Testing Services is required.
Check one *
Destiny One online payment system Mail-in

Destiny One online payment system is by credit card.

Mail-in: NECC, 100 Elliott St., Haverhill, MA 01830, Academic Placement & Testing, Attn: Donna Felisberto.
Electronic Signature *
Maximum of 40 characters. Currently Used: 0 characters.
Date * MM / DD / YYYY
Do Not Fill This Out