Internal Trainer Request for Exam Codes and/or Request to Proctor

Name:(Required)

First Last

Email:(Required)

What do you need help with?(Required)

Please choose one.

Email Address to use as a Proctor in Webassessor:(Required)

This can not be the same as the address you used as a test taker in Webassessor.

Phone you can be reached at while proctoring:(Required)

Exam you are requesting to proctor:(Required)

Applicable discounts apply to KCS Practices Exam and Practice Test (see below). Trainer exam will be invoiced at list price.
Choose one:

Include the practice test? ($85 list price less applicable discount below)(Required)

Yes

Date the exam will be administered:(Required)

Maximum number of students taking the exam:(Required)

Name of exam location:(Required)

Address of the exam location:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Approximate time the exam will be started:(Required)

Exam location time zone:(Required)

Percent Discount your company receives

All companies who have purchased the corporate license for training, receive a 10% discount off the price of exams. Consortium Membership provide additionally discounting as outlined below regardless of exam delivery method

10% Consortium Non-member

10% + 10% Participant Level Membership

10% + 15% Participant Plus Level Membership

10% + 20% Sponsor Level Memberhsip

10% + 25% Benefactor Level Membership

Notes:

Any additional things you would like us to know?

By submitting this form, you agree:

you are responsible for distributing exam codes to test takers, and
to be invoiced at list price less the applicable discount.

Exam you are requesting codes for:(Required)

Choose one:

Include the practice test? ($85 list price less applicable discounts below))(Required)

Yes

Approximate date of associated workshop:(Required)

Last day to register for the exam:(Required)

Please enter the date that a student must register for the exam by.
Best practice: last day of the month of the workshop or 30 days from workshop.

Last day the exam can be taken:(Required)

Please enter the date a student must complete the exam by.
Best practice: within 60 days of workshop.

Approximate number of coupon codes needed:(Required)

You will only be charged for coupon codes used.

Percent Discount your company receives(Required)

10% Consortium Non-member

10% + 10% Participant Level Member

10% + 15% Participant Plus Level Member

10% + 20% Sponsor Level Member

10% + 25% Benefactor Level Member

Notes:

Any additional things you would like us to know?

By submitting this form, you agree:

you are responsible for distributing exam codes to the test takers,
to communicate the Kryterion reschedule/cancellation policy to the test takers, and
to be invoiced at list price less the applicable discount.

Name

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