Request Form

Remote Placement Test Request

First & Last Name

Address 1

City

State

Zip Code

Social Security Number (including dashes)

Email Address (vicdemon@nsula.edu)

Primary Phone

Cell Phone

Date of Birth

Test Subject (Math, English, or both)

Credit Card Number (xxxx-xxxx-xxxx-xxxx)

Expiration Date

Billing Address

Pressing submit authorizes the cardholder to be charged the payment amount.

All fees paid are nonrefundable and must be paid at the time of appointment request.

Student Conduct is a part of the Office of Student Development • NSU Box 5307 • 309 Friedman Student Union Building • Natchitoches, LA 71497 • 318-357-5286 • 318-357-6502 (fax) • Email Frances Conine @ coninef@nsula.edu • Sonia Kay @ kays@nsula.edu

A division of the Office of Student Affairs

Louisiana Transfer Associate Degree Program (AALT/ASLT)
Official Web Page of Northwestern State University of Louisiana. Member, University of Louisiana System