Fillable Students requesting their ASSESSMENT Test Scores be sent (Cascadia Community College)

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Students requesting their ASSESSMENT Test Scores be sent (Cascadia Community College)

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Students requesting their ASSESSMENT Test Scores be sent via US POST or FAX should complete and
submit this form to the Kodiak Corner Front Counter.
Students requesting their ASSESSMENT Test Scores in person for pick up are NOT required to
complete this form, present photo ID at the Kodiak Corner front counter and request test scores.
STUDENT INFORMATION
NAME
PREVIOUS NAME
STUDENT ID #
BIRTHDATE
PHONE #
EMAIL ADDRESS
INFORMATION REQUESTED
APPROXIMATE TEST DATE
HOW MANY COPIES OF TEST
SCORES
TEST TYPE
ENGLISH & MATH
ENGLISH ONLY
MATH ONLY
SELECT ONE OF THE
FOLLOWING
OPTIONS
FAX TO:
( ) -
ATTN:
MAIL TO:
STUDENT
SIGNATURE
X
DATE
**For Official Use ONLY**
ES RECVD
DATE RECVD
COMPLETED
READY FOR PICK UP FAXED MAILED
ES INITIALS
DATE COMPLETED
REVISED JW 11/2016
ASSESSMENT SCORE REQUEST
Submitted with photo ID to the Kodiak Corner’s Front Counter.
Cascadia College is an equal opportunity institution and does not discriminate on the basis of race, color, religion, gender
and/or sex, disability, national origin, citizenship status, age, sexual orientation, veteran’s status, or genetic information. All
Cascadia materials are available in alternative formats and can be requested by contacting the Human Resources office.
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Students requesting their ASSESSMENT Test Scores be sent (Cascadia Community College)

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Completed 27 July 2020

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