TAGME Registration - 2018 Assessment Retakes

Question Title

* 1. Demographic Information

Name

Institution/Program Specialty

Program Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Personal Email Address (NO .edu, .org or .gov allowed)

Contact Phone Number

Question Title

* 2. Certificate Information

Name as it should appear on your certificate

Address to mail certificate

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Question Title

* 3. Will you need any special accommodations to take the assessment?

Yes (Further information will be provided)

No

Question Title

* 4. By checking the box below, I understand I am still bound by my positive affirmation of TAGME's Attestation Statement for Certification guidelines of my initial or maintenance of certification application.

Agree

Disagree

Thank you for completing this registration. We will reach out in a few weeks with instructions to schedule your retake assessment date, location and time.