School of Psychology & Counseling

CPCE Exit Exam Registration Form

Exit Exam Registration Form
Exam Date:

Friday, April 12, 2013
Virginia Beach campus – CRB 107

Exam Time: 9:00 AM – 1:00 PM

**REGISTRATION CLOSES ON Friday, March 15, 2013**

(ALL FIELDS ARE REQUIRED)

First Name:
Last Name:
Street Address:
City:
State:
Zip Code:
Phone: ( ) -
Email Address:
   
What is your track in the Master’s Program?

Dual
CACS
 
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 & Counseling clicking "Submit" button below. You should receive a confirmation email upon clicking "Submit". If you do not receive one, contact the Field Placement Liaison, Karen Mercer, at karemer@regent.edu.

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