Approved Training Facility Test Date Request

Approved Training Facilities only:
If you would like to request a testing date/dates for your students, please complete the form below.

Please note that this form is for facility use only. This is NOT an application to test.

  1. Approved Training Facility Name:
  2. Facility Number:
  3. Contact Name:
  4. Mailing Address:
  5. City:
  6. State:
  7. ZIP Code:
  8. Daytime Phone:
  9. Email Address:
  10. Requested Testing Date(s):
  11. Number of Candidates to Be Tested:
  12. Preferred Testing Location:
    Your Facility
    Ivy Tech
  13. Questions/Comments:

Contact our office for assistance.