LASERGRADE Computer-based testing

Company Directors

About

We appreciate your interest in becoming a LaserGrade testing center. However, we are not currently seeking any additional locations for certification and licensure testing at this time. If you are an FAA ground school and are interested in delivering FAA examinations, please complete an application and our FAA Program Manager will contact you.

* Indicates required field. We may not be able to move forward on your application without the required information.

* Company Name:
* Street address:
* City:
* Country:
* State/Province:
* Zip/Postal code:
Mailing address (if different):
-- City:
-- Country:
-- State/Province:
-- Zip/Postal code:
* Business Phone:
* FAX:
Web Address:
* Type of Business:
* Years in Business:
* Expected # of Tests per Year:
Technical Contact:
Technical Contact Direct Phone:
Technical Contact E-mail:
* Testing Center Manager:
* Manager's Direct Phone:
Manager's E-mail:
* Are you currently providing computer based testing?
	Yes No
If yes, please list your test provider(s):

* Please list any associations your organization is affiliated with (CompTIA, AATP, NAEC, NAAP, LAEC etc.):

EXECUTIVE CONTACT (Owner, President, Director etc.)

* Executive's Name:
* Phone:
* Fax number:
* E-mail Address:

TEST CENTER INFORMATION

* Please indicate whether your testing center will be private or public:
Private (For internal testing only)
Public (Testing open to the general public - includes participation in LaserGrade's Advertising Cost Share Program)

FAA Site Application

Complete this section of the application only if you elect to administer Federal Aviation Administration tests. Otherwise, go directly to the Testing Center application signature section below.

***PLEASE NOTE***

FAA Order 8080.6D requires FAA testing centers to receive training from LaserGrade and written approval from the FAA.

TEST CENTER SUPERVISOR DESIGNATION

Indicate name of person designated as Testing Center Supervisor (TCS). This person is responsible for day to day testing activities and insures compliance with LaserGrade and FAA testing procedures and policies. The TCS must be present during at least 50% of test administration business hours.
Please note that if you are a DME or a DPE you cannot be a Testing Center Supervisor.

Name:

LOCATION INFORMATION

Is your business located on an AIRFIELD?	Yes No
If yes, please name the airfield:

FAA VIOLATION INFORMATION

		Yes	No
1.	Has the Testing Center Supervisor ever been cited with an FAA violation or been involved in any FAA enforcement action?
2.	Is there now or has there ever been any FAA administrative action involving your business?
3.	Has the Principal person ever been involved with FAA computerized testing?
4.	Has the TCS ever been involved with FAA computerized testing?

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:

Upon submitting your testing center application, a LaserGrade representative will contact you to confirm receipt of your application and to discuss all of the testing options available to your organization.

Please note that submitting an application is only the first step of the application process, and is not a guarantee of approval. You may be contacted by LaserGrade for further information prior to LaserGrade making a final determination.

Additional comments or questions.

Click on "Submit Form" box below to send via the internet

SEND APPLICATION TO:
LaserGrade Computer Testing
P.O. Box 87245
Vancouver, WA. 98687-7245
Fax: (360) 891-0958