First Name:
Last Name:
Street Address:
City:
State:
Zip Code:
Phone:	( ) -
Email Address:

What is your track in the Master’s Program?	Community School CACS

Where do you plan on taking the exam?	Virginia Beach campus Washington, DC campus

What is your anticipated graduation date?


Have you completed the minimum of 30 hours of coursework required to take the exit exam?	Yes No

Have you previously taken the exit exam?	Yes No

(all the fields are required)

Thank you for taking the time to fill out this form. To submit your request to the School of Psychology and Counseling clicking "Submit" button below. You should receive a confirmation email upon clicking "Submit" If you do not receive one, contact the Field Placement Coordinator Kara Hanger at khanger@regent.edu.


Regent University School of Psychology & Counseling 1000 Regent University Drive, CRB 154, Virginia Beach, VA 23464 SPC Admissions 800.681.5906 or 757.352.4498 All Other Offices 800.373.5504 or 757.352.4000 Contact Us
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