Regina High School Exam Registration Form

Exam Registration Form

Please use the form below to register for the examination.
= Required fields

Start by selecting a date for taking the exam. All exams are scheduled from 8:00 a.m. until Noon.

Saturday, October 10, 2009 (Scholarship)

Saturday, November 7, 2009 (Scholarship)

Saturday, November 21, 2009 (Placement Only)

Student Information

Parent/Guardian Name:
First Name:
Last Name:
Current School:
Current Grade:
Home Address
Street Address:
City:	Zip:
Phone:	(with area code)
Alt. Phone (mobile or parent's work ):	(with area code)
Student Email Address:
Parent Email Address:
How did you hear about the test?

The exam fee is $15.00, which you may pay in cash or check the morning of the exam.	Use the box below to send your comments or questions:

For more information, contact Katie Niemczura,
Director of Admissions

216.382.2110 x 248