To have your COMPASS results forwarded to a third-party, complete this form,

enclose a check or money order for $10.00 (please do not send cash), and mail it to

Southwestern Community College

Assessment Center

1501 W. Townline St.

Creston, IA 50801

Questions? Phone (641) 782-7081 Ext. 320 or email werner@swcciowa.edu

Social Date of

Security No. Birth

Your

Name

Street

Address

City

State/Zip

Maiden or Test

Previous Name(s) Type

(Please print name and address to which test scores are to be sent.)

Send

Record to

Street

Address

(or Fax Number)

City

State/Zip

I have enclosed the $10.00 processing fee with this form. I understand that if I do not enclose the processing fee, this form will be returned to me and my scores will not be transferred.

___________________________________________________________

Signature* Date of Request

*Signature is required for transfer of scores.