Kankakee Community College
Testing Services
Placement Score Release Form
If you have taken the placement test with Kankakee Community College and wish to release an official copy
of your scores to another institution, please follow the directions below. There is a $5 fee to release scores. If you have
any questions, contact the Testing Services office at 815-802-8530.
1. Print and complete this form.
2. Make a copy of your driver’s license, state ID, passport, or military ID.
3. Return the completed form, copy of your ID, and the $5 fee (make checks payable to KCC) to the
Accounting office in person or by mail.
Kankakee Community College
Accounting Office
100 College Drive
Kankakee IL 60901
Where do you want the scores sent?
Once we have received all necessary paperwork and payment, we will send an official copy of your scores to the
institution indicated below.
Student name:
KCC Student ID: SS# Last 4 digits: Date of birth: / /
Student phone: - -
Institution, department, name & address:
Which placement scores would you like released?
I give KCC permission to release my placement scores to the institution indicated above.
Signature: Date:
Paying with a credit card, fill out the below information
Name on credit card:
Account number:
Type of card: Expiration date: Security code:
Cleared date: By:
$5 Score release fee Date paid: By: Receipt no.:
Date sent: By:
Complete online then print. OR print and fill in manually.
( )
Street address
Zip code
Rev. 3/2016