Rockingham Community College
Testing Center
Score Request Form
This form must be completed and signed by the student.
Requests cannot be processed without the student’s signature.
Allow 2 business days for processing.
Please mail or fax your request to the address at the bottom of this form.
Scores older than 3 years are considered to be outdated and cannot be verified by RCC.
Typed signatures will not be accepted. All signatures must be in writing.
Please Print
Name:
Social Security #: __ __ __ - __ __ - __ __ __ __
Any Other Last Name:
Address: Date of Birth:
Year First Enrolled at RCC:
Approximate Test Dates:
Please forward copies of my placement test and/or ASSET test scores to:
*Official Copy for Student Pick Up Unofficial Student Copy (Student Pick Up)
*Official Copy To Be Mailed To Student Unofficial Student Copy (Mail to Student)
*Official Copy Mailed to Another Institution
School/Name & Address
to be mailed:
* SCORES MUST REMAIN IN A SEALED ENVELOPE TO BE “OFFICIAL”.
It is the responsibility of the student to verify whether the receiving institution received a copy
of his/her test scores.
Studen
t's Signature
Date
PO BOX 38
WENTWORTH, NC 27375
(336) 342-4261 ext. 2225
FAX: (336) 634-0609
TTY: (336) 634-0132
X
X X X X
Phone:
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