Cape Fear Community College
Career and Testing Services
411 North Front Street
Wilmington, NC 28401-3993
Attn: Ms. Betty Northam

Fax Number: 910.362.7080

PERMISSION FOR RELEASE OF TEST SCORES

Please complete this form, print, and mail to the above address: This form is not valid unless you have signed the "student's signature" line below.

Please send the results/transcript of my Placement Test Scores

PSB

 

College Name/Agency:
Address (street/box #):
City:
State: Zip:

 

 

STUDENT INFORMATION

 

Last Name:
First Name:
Middle Name:
Former/ Name:
Address:
City:
State: Zip:
Telephone: Without spaces or dashes
Date of Birth:
Social Security No.: Without spaces or dashes
Date Test Taken: or year

 

My signature below authorizes release of my test scores to College/Agency
stated above.

Student's Signature ____________________________ Date _____________

 

Office Use Only

Date Released ______________________ By_______________________________________