Online Distance Testing Registration Form

Please Note:

• Complete this registration form using your credit card. Be certain to provide one first choice date and one second choice date.

• You may schedule one (1) examination per test date.

• Once we receive your complete registration information, you will receive a confirmation of your scheduled test date.

1. Personal Information:

Last Name	First Name	Middle Initial

Street Address	Apt.	City	State	Zip Code

Day Telephone	Ext.	Evening Telephone	Cellular Phone

Email Address	Social Security Number	Date of Birth (mm/dd/yyyy)

Sex	Height	Color of Hair	Color of Eyes
Male Female

2. Examinations Information:

First Choice Test Date	Time	Second Choice Test Date	Time

WPU Service Fee per exam
$30.00

We will contact you to make any necessary arrangements before your test date.

Examination for which you are registering	Institution Name

Check One	Timing of Exam (length)
Computer Paper DSST (DANTES)

3. Additional Information:

Please indicate additional information, questions, comments below.

Terms and Conditions:

Administration fees are non-refundable.
Re-scheduling of appointment requires 48 hours notice to avoid a $15 re-scheduling fee.
No admittance once testing commences; re-scheduling of appointment will incur a fee of $15.
Must present a paper copy of William Paterson University admission ticket and appropriate photo ID.
Candidates must report to:
William Paterson University Valley Road Campus
1600 Valley Road - Room 1019
Wayne, NJ 07470
Arrive 15 minutes prior to your scheduled appointment.

I agree to the terms and conditions.