Bilingual Placement Test Registration Form

Please complete the information below to reserve a seat for the ESL/Bilingual Placement Test. Be sure to include your native country and your mother tongue (the first language you spoke as a child). For any questions or to make a reservation by phone, please call (716) 851-1079.

First Name:
Last Name:
Zip Code:
Email Address:
Phone Number:
Male   Female
Diploma Type:
High School Diploma   GED
Native Country:
Native Language:
Referring Agency:
Test Date: