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HTPC Entry Level Proficiency Exam Application
    Applicant Information:
  1. First Name(*)
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  2. Last Name(*)
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  3. Address(*)
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  4. City(*)
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  5. State/Province(*)
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  7. Country(*)
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  8. Contact Phone(*)
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  9. Email(*)
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  10. Applicant Level(*)

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  11. Proctor Information:
  12. Contact First Name(*)
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  13. Contact Last Name(*)
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  14. Job Title or Profession(*)
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  15. Proctor Contact Phone(*)
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  16. Email(*)
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  17. Name(*)
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    Name to Send Test Materials to (written exam only)
  18. Address(*)
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    Address to Send Test Materials to (written exam only)
  19. Ctiy(*)
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  20. State/Province(*)
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  21. Zip/Postal Code(*)
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  22. Country(*)
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  23. Test Preference: Select and complete Only 1
  24. Test Preference(*)

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  25. Written Test Requested Test Date:
  26. Written Test Requested Test Date
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    If you chose "Pencil and Paper Test" for your Test preference then please enter the date you plan to take the written test.
  27. Computer Test Date Requests:
  28. Computer Test Requested Date
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    If you chose "Computer Test" for your Test preference then please enter date requested for computer based test.
  29. Computer Test Alternate Date
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    If you chose "Computer Test" for your Test preference then please enter alternate test date requested for computer based test.
  30. Submit Application and Make Payment:
  31. Accreditation Exam price is $200.00 USD (non-refundable)
  32. Total Price
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  33. Anti-Spam Protection
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  34. Submit Application and Make Payment

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