Revised 7/31/18 C:\Users\hmb\Documents\Forms\Examity Remote ACCUPLACER.docx
Phone: 928-344-7641 Fax: 928-344-7712
ACCUPLACER Test Request using Examity
Examity remote online proctoring enables candidates to take the ACCUPLACER test at any
location. The cost for this service is $25.00. Complete the information below. All fields are
required. The estimated processing time is three business days. Please email or fax this form to
testing@azwestern.edu or (928) 344-7712.
Student Information
First Name: Last Name:
AWC Student ID #: Date of Birth:
Email: Phone number:
Address:
City: State: Zip Code:
Type of Test (Check all that apply): English Math ESL
Student Quick Guide: https://bit.ly/2H0Y6Zy.
Technology Requirements: https://examity.com/accuplacer-students/
Frequently asked questions: https://examity.com/accuplacer-faq/
For Office Use Only
Voucher #: _____________________________
Processed: ______________________________
Email Sent: ______________________________
PVF Received: ______________________________
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