Request for Remote ACCUPLACER Voucher

First Name *

Last Name *

Student ID

Date of Birth *

Phone *

Email to send the voucher to *

Address *

City *

State * - Select a State - Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

First Time Section(s) to Take *

• Next-Generation Arithmetic
• Next-Generation Quantitative Reasoning, Algebra, and Statistics
• Next-Generation Reading
• Next-Generation Writing

If you are retesting, there is also a retest fee per section paid to the Hawkeye Business Office. Retesting fees need to be paid before a voucher can be created with the proctoring service. See the Retesting Policy for more information.

Section(s) to Retake

• Next-Generation Arithmetic
• Next-Generation Quantitative Reasoning, Algebra, and Statistics
• Next-Generation Reading
• Next-Generation Writing

Proctoring Service *

• Examity Live Proctoring + Audit, $25
• Examity Automated Recorded Proctoring + Audit, $10

Payment of Proctoring Service Fees

All payments for the remote ACCUPLACER voucher are paid directly to the proctoring service. Hawkeye Community College cannot take the proctoring payment.

Instructions on how to pay will be in your voucher email sent to the email provided on this form. If someone other than yourself will be paying the proctoring fee, please provide them with your voucher number and they will need to call the proctoring service to pay. 

I understand that all proctoring service fees must be paid directly to the proctoring service. Hawkeye Community College cannot take the proctoring payment. *