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Student Name:
Student Email:
Student ID:
Verified Identity:
Request_ID:
Submit Date:
Former name:
Completion of this form authorizes the Testing Center to send all of your placement scores from Heartland Community College to the email addresses you indicate below.
Institution:
Authorized recipient email:
Authorized recipient name:
Confirm email:
I understand by checking this box and typing my name below, I am authorizing the Testing Center to release test scores.
Type name below:
Submit Request