Northeast Iowa Community College
Placement Score Release Form
Please submit completed form with payment to a NICC Test Center to authorize release of
your placement scores.
Last Name:
State: Zip Code:
Student Information
First Name:
Former Name:
Date of Birth:
Mailing Address:
City:
Email:
Contact Phone Number:
Name of
Institution to Receive Test Scores
Institution Name:
Mailing Address:
City:
State:
Zip Code:
Attention to:
Placement Scores to send: ACCUPLACER ($20.00
)
ALEKS ($20.00)
To authorize release of placement scores, please return this completed form along with full payment
($20.00 for one or $40.00 for both) to:
Peosta Testing Center
Northeast Iowa Community College
8342 NICC Drive
Peosta, IA 52068
800.728.7367, ext. 226
**Email: testproctorp@nicc.edu
Calmar Testing Center
Northeast Iowa Community College
PO Box 400
Calmar, IA 52132
800.728.2256, ext. 311
**Email: testproctorc@nicc.edu
**Please note if you email your form, your request will not be processed until payment has been
processed.
To pay by credit/debit, please call Calmar Business Services at 800-728-2256, ext.204 or Peosta
Business Services at 800-728-7367, ext. 202.
Student Signature:
Date:
4/2018
