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:
Contact Phone Number:
Name of
Institution to Receive Test Scores
Institution Name:
Mailing Address:
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
Calmar Testing Center
Northeast Iowa Community College
PO Box 400
Calmar, IA 52132
800.728.2256, ext. 311
**Please note if you email your form, your request will not be processed until payment has been
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: