Office of Student Assessment
Test Score Release Form

Please complete all necessary fields before submitting form:
Last Name:

First Name:

Middle Initial:

Student ID:
Student Phone Number:
Send Scores to:  
School Name:
Address:
City:
State:
Zip:
FAX Number: (If requesting sent by FAX)
Send By: FAX Mail
 
Place "X" in box to indicate signature By checking this box, you agree for Midlands Technical College to release your placement assessment scores to the school listed above.
Date: