Special Testing Center Request Form

This Form is for Candidates Testing Outside the US

Name: *

Street Address/PO Box *

Address Line 2

Preferred City: *

Preferred Country: *

Zip/Postal Code

Email Address *

Exam Selection

Please select a testing window: *

Select one exam or more *

Part I

Part II

Recertification

If selecting Part II, please select your track options(s):

NIOM

General CNP

CC-EEG

Payment

A fee of $200.00 is required to submit the Special Testing Center Request Form. *

Outside the US Testing Fee ($200.00)

*Click Continue to complete payment.