Field Test Site Form

Please complete and submit the following information to express your interest to be a field test site for Skill Connect Assessments. For definitions of population categories and user groups, scroll down to the bottom of the page. This form may be submitted multiple times as additional assessments are available for field testing.

	Site Name: * Contact Name: * Address * City *
	Select State: -- Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
	Zip Code: Phone: Fax: Email:
	Based off the following table, what is your population category? City Suburban Town Rural
	Are 20 computers available for testing at any given time? Yes No
	If not, how many computers would be available for testing?
	Please provide information about the assessment groups you are interested in supporting. Sites may test more than one assessment and need not (but preferably would) provide all four groups for each assessment. Please populate each field with the number of students that you anticipate for each category. Expert 1st Year 2nd Year Control Automated Manufacturing Commercial Baking Computer Maintenance Cosmetology Employability (Secondary) Employability (Post-Secondary) Internetworking Nail Care Welding