Accuplacer Voucher Request Form

First Name^*

Middle Name

Last Name^*

Email Address^*

Re-enter your Email Address^*

Phone Number^*

Birth Date^*

Address 1^*

Address 2

City^*

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

Zip Code^*

StarID^*
StarIDs are a combination of letters and numbers like "ab1234yz.

What is your desired program of study?^*

Have you applied for admission to Southeast? ^*

Are you a current high school or home-schooled student who has NOT taken the MCAs and needs the Accuplacer for PSEO eligibility or placement? (Note: PSEO students cannot take the Accuplacer to override their MCA score; if the MCAs have been taken, we must use that score for eligibility and placement.) ^*

Do you have a previous college degree or college course(s) that may transfer? ^*

Do you receive support through Minnesota State College Southeast’s Office of Accessibility? ^*

Is there anything you would like the Accuplacer proctor to know as they prepare your voucher? (e.g. you are planning on entering the nursing program and would like to take the math test)