Score Request « Southern Regional Testing Agency

Please fill out the Score Request form below.

Score Request

Personal Information
Name*
First Middle Last
If your name has changed, please fill in your original name.
Madien Name (If applicable)
Last
Last 4 digits of SSN*
Phone*
Email*
Enter Email Confirm Email
Exam Details
Year You Took the Exam*
Exam Location*
Exam type:*
Have you taken the exam more than once?
- Yes
If yes, please enter additional exam locations and years.
Do you want your score request notarized? (Extra $5)*
- No
- Yes
Address to Send Scores
Institute:
Address
Street Address Address Line 2 City State ZIP Code
- Same as Current Mailing Address
Current Mailing Address
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Physical Address, no PO Boxes
Comments
Fee Information
Duplicate Score
Price: $35.00
Notarize
Price: $5.00
Total
$0.00
Payment Information*

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Visa
Card Number Expiration Date Security Code Cardholder Name

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Our Mission

SRTA will continue to provide valid, reliable, legally defensible examinations and results while striving to implement new testing methodologies in a candidate friendly environment for the next generation of dental professionals.

Southern Regional Testing Agency (SRTA)

4698 Honeygrove Rd., Suite 2
Virginia Beach, VA
23455

Office Hours
Monday – Friday 8:30a.m. – 5:00p.m. EST
phone: (757) 318-9082 | fax: (757) 318-9085

Score Request

Score Request

Personal Information

Exam Details

Address to Send Scores

Current Mailing Address

Fee Information

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