Form for I/C to request exam dates. Course Number*Region*Region 1Region 2Region 3Region 4Region 5NH I/C*Daytime TelephoneContact Person*Daytime TelephonePractical Examination date/time requested (list three [3] choices)1st Date* Date Format: MM slash DD slash YYYY Time* : HH MM AM PM 2nd Date Date Format: MM slash DD slash YYYY Time : HH MM AM PM 3rd Date Date Format: MM slash DD slash YYYY Time : HH MM AM PM Location*Facility*Can you take outside students*YesNoNumber of StudentsIf you are not able to accept outside students, please provide an explanation for approval consideration.*Request for closed exams will be considered on a case-by-case basis.Max NumberCostHow will students register for this exam?*