-- Test Site Selection Form --
This form must be completed in addition to any registration or add/drop processed through your school.

CIDDE Academic Testing, University of Pittsburgh
Alumni Hall, Room 824
4227 Fifth Avenue, Pittsburgh, PA 15260
Phone: (412) 624-7215
Fax: (412) 624-6059

Term:

Is this your first Distance Education course?

Name:

Address:

E-Mail:

PeopleSoft number:

Telephone:

Daytime:
Evening:

School or Campus in which you are enrolled:

(Please choose one of the following Testing Sites)

	University Sites:		Other Sites:
	Oakland Campus (CIDDE Office) Room 824 Alumni Hall 4227 Fifth Avenue Pittsburgh, PA 15260		B.F. Jones Memorial Library 663 Franklin Avenue Aliquippa, PA 15001
	Bradford Campus Hanley Library University of Pittsburgh Bradford, PA 16701		Bethel Park Public Library 5100 West Library Avenue Bethel Park, PA 15102
	Greensburg Campus (138 McKenna Hall) University of Pittsburgh Greensburg, PA 15601-5898		Citizens Library 55 South College Street Washington, PA 15301
	Johnstown Campus Owen Library University of Pittsburgh Johnstown, PA 15904		Monessen Pubic Library 326 Donner Avenue Monessen, PA 15062
	Titusville Campus Haskell Library University of Pittsburgh 520 E. Main Street Titusville. PA 16354		Shaler-North Hills Library 1822 Mt. Royal Blvd. Glenshaw. PA 15116
	Proctor System Approved only under extreme circumstances (412) 624-7215		St. Mary's Community Education Council of Elk & Cameron Counties 4 Erie Avenue, Suite 200 St. Marys. PA 15857

-- Test Site Selection Form -- This form must be completed in addition to any registration or add/drop processed through your school.

-- Test Site Selection Form --
This form must be completed in addition to any registration or add/drop processed through your school.