South Plains College – Levelland
1401 S. College Avenue Levelland, TX 79336
Phone: (806) 716-2367, 716-2530 or 716-2577
Fax: (806) 897-0371
AUTHORIZATION TO RELEASE ACCUPLACER TEST SCORES
_________________________________ ______________________________
Last Name
First Name
_________________________________ ______________________________
Social Security Number
Date of Birth
_________________________________ ______________________________
*Test Date(s)
Telephone #
I, ___________________________, hereby authorize the Testing Center at
South Plains College – Levelland to release my ACCUPLACER
Scores to:
________________________________ _______________________________
Name and City of College/University
Name of Administrator
________________________________________________________________
Address of College/University
________________________________ _______________________________
Fax # of College/University
Telephone # of College/University
_______________________________ _______________________________
Student’s Signature
Date
*I understand that this release if for the specified test date(s) only.
7/25/2016