Exam Retake Request

Please use the fields below to request an exam retake.

Fields marked with an * are required

Full Name *

Last Four of SSN *

Email *

Confirm Email *

Address *

City *

State *

Zip *

Licensure Type Requested *

Exam Retake Type Requested *

Fields marked with an * are required

Name *

Address

City

State

Zip

Registration Number OR Last Four of Your SSN *

Phone

Email *

Confirm Email *

Please contact me by:

Phone
Email

Comments *