TSIA2 Remote Testing Request Form
Testing Center-Kilgore Campus1100 Broadway Kilgore, TX 75662903.983.8215 phonetesting@kilgore.edu
Kilgore College students planning to test at an institution other
than KC must follow the procedures listed below to request a remote voucher.
1. Submit the Kilgore College admissions application online at www.applytexas.org at least one week prior to
requesting a testing appointment.
2. Pay the non-refundable $40 (full test) or $20 (partial test) fee to the Cashier’s office by phone at 903-983-
8108, online at https://www.kilgore.edu/future-students/student-services/testing-services/testing-center-
kilgore#t-tsi or in person and provide the receipt number on this form. You may also be required to pay a
proctoring fee to the institution or vendor providing the proctoring service.
3. Complete the pre-assessment activity located at www.kilgore.edu/testing-kilgore and provide a copy of the
email verification of completion.
4. Submit this form at least 2 days prior to your desired test date (weekends and holidays excluded).
Special Note: Vouchers will not be issued or accepted during college holidays, late registration or heavy testing
periods such as finals weeks.
Student Information
Last Name_________________________First Name______________________Middle_________________
Address___________________________City___________________State_______Zip________Country____
Student ID______________________Ethnicity: White African American Hispanic Other
Gender Male Female Date of birth (mm/dd/yyyy)____________________________
Email____________________________ Home Phone________________Mobile Phone_________________
Payment Confirmation/Receipt number____________________ Amount paid_________________________
Select the section to be taken: Full Test English Language Arts & Reading (ELAR) Math only ELAR &
Math (without essay) TSIA2 WritePlacer Essay (must have a passing score on the ELAR test)
Proctor Information
Name of Remote Testing Site__________________________City ____________________State____Zip______
Examity Remote Vendor (select when testing at home)
Student Certification
I certify that the information provided is true and correct to the best of my knowledge. I agree to follow all testing
procedures and guidelines. I understand that I must complete my exam within 14 days and understand that my
testing voucher and payment are only valid for 90 days. I further understand that any prohibited behavior on my
part will result in the cancellation of my scores.
Signature___________________________________________Date________________________________
Submit this form by email to testing@kilgore.edu or fax to 903-988-3707.
Updated 1/2021
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