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Test Score Release Form
Complete all fields in the form. Fill out an additional request if a second copy is to be sent to another
address. After completing this form it must be submitted to testingcenterscores@durhamtech.edu.
Please allow two business days for the request to be processed. Exams administered at other
institutions will not be released. Incomplete forms cannot be processed.
Last Name _________________________________ First Name ____________________________
Previous Name _______________________________________________________________________
Street Address _______________________________________________________________________
City ___________________________ State___________________ Zip Code _______________
Phone Number _____________________________ Date of Birth _______________________
Durham Tech Student ID# _________________ Social Security Number (last four digits only) ________
Email Address ________________________________________________________________________
What version of the test did you complete?
☐ Compass ☐ NCDAP ☐ Rise
Release my scores by (choose one): ☐ Email ☐ Mail ☐ In person* (must show photo ID)
Mail scores to:
Email Scores to: Name __________________________________________________________
Email Address ___________________________________________________
☐ By checking the checkbox, I authorize Durham Technical Community College to disclose the following
information regarding my test scores. No one may request your scores without your written permission and
signature. If you wish a copy of your scores to be picked up by anyone other than you, you must indicate this at
the time of the request or give written permission with your signature to the person authorized to pick up the
score.
Date ________________
*Pick up at the Testing Center, Phail Wynn, Jr. Service Center (Building 10), room 10-300, Durham Technical
Community College, 1637 East Lawson Street, Durham, NC 27703
