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Before completing this application, please confirm that you meet the PSI Site Requirements (Testing Center Requirements and Computer Specifications)

YesNo

If no, please comment below:

General Information
First Name *	Last Name *
Title	Company *
Business Phone *	Email Address *
Fax *	Web Site
Street Address *
City *	State ---ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
Postal Code/Zip *	Country * ---United States of AmericaUnited KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAscension IslandAshmore and Cartier IslandsAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NationsCayman IslandsCentral African RepublicChadChannel IslandsChileChinaChina-TaiwanChristmas IslandsCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote D'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDiego GarciaDjiboutiDominican RepublicEcuadorEgyptEireEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIrelandIsraelItalyJamaicaJapanJordanKazakstanKenyaRepublic of Korea (South Korea)KuwaitKyrgystanLaosLatviaLebanonLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalaysiaMaltaMauritiusMexicoMoldovaMonacoMoroccoMozambiqueNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayPakistanPanamaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaSaudi ArabiaSingaporeSlovakiaSloveniaSomaliaSouth AfricaSpainSri LankaSudanSwedenSwitzerlandTaiwanTanzaniaThailandTrinidad and TobagoTunisiaTurkeyUgandaUkraineUnited Arab EmiratesUruguayVenezuelaVietnamYemenYugoslaviaZaireZambiaZimbabwe

Mailing Address (if different)
Street Address
City	State ---ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
Postal Code/Zip	Country ---United States of AmericaUnited KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAscension IslandAshmore and Cartier IslandsAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NationsCayman IslandsCentral African RepublicChadChannel IslandsChileChinaChina-TaiwanChristmas IslandsCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote D'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDiego GarciaDjiboutiDominican RepublicEcuadorEgyptEireEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIrelandIsraelItalyJamaicaJapanJordanKazakstanKenyaRepublic of Korea (South Korea)KuwaitKyrgystanLaosLatviaLebanonLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalaysiaMaltaMauritiusMexicoMoldovaMonacoMoroccoMozambiqueNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayPakistanPanamaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaSaudi ArabiaSingaporeSlovakiaSloveniaSomaliaSouth AfricaSpainSri LankaSudanSwedenSwitzerlandTaiwanTanzaniaThailandTrinidad and TobagoTunisiaTurkeyUgandaUkraineUnited Arab EmiratesUruguayVenezuelaVietnamYemenYugoslaviaZaireZambiaZimbabwe

Industry/Business Information
Type of Business * ---NoneAgricultureApparelBankingBiotechnologyChemicalsCommunicationsConstructionConsultingConsumer GoodsEducationElectronicsEnergyEngineeringEntertainmentEnvironmentalFinanceFood & BeverageGovernmentHealthcareHospitalityInsuranceIO ConsultingIO Selection / AssessmentMachineryManufacturingMediaNot For ProfitOtherPharmaceuticalPublishing/PrintReal-estateRecreationRecruitment/StaffingRetailShippingTechnologyTelecommunicationsTransportationUtilitiesOther
Years in Business * ---0-10 Years11-20 Years21-30 YearsOver 30 Years	Expected Number of Tests per Year * ---1-100101-200201-300301-400401-500500+

Executive Contact (Owner, President, Director etc.)
Executive's Name *	Phone *
Fax *	Email Address *

Additional Information
Are you currently providing computer based testing? YesNo
If yes, please list your test provider(s)
Do your test center administrators also deliver training associated with PSI exams? YesNo
If yes, please list below:
Do you meet the local country standards for disability access into and inside the building? YesNo
If no, please comment below:
Please list the Top 10 Training Programs your organization is affiliated with (ISACA, AWS, CompTIA, AATP, NAEC, NAAP, LAEC, etc.)*
Which products and services do you have questions about? AbilityComputer/Keyboarding SkillsConsulting ServicesLeadership AssessmentGovernment-specific TestsPSI 360RIF AnalysisCertificationIndustry-specific TestsPersonality/AttitudePre-hire AssessmentTest Administration CentersKnowledge TestsDesktop Assessment Center
Comments or Questions

Testing Center Application Signature
I certify that the above information is true to the best of my knowledge as of the date indicated below. (If submitting this application via the internet, please type name in signature box below)
Signed *	Date *