PRAXIS REQUEST FORM
• To ensure prompt processing, provide all information requested.
• Your signature is required to release your Praxis record.
• VCSU does not charge a fee for Praxis requests.
This form may be mailed, faxed, or delivered to:
School of Education & Graduate Studies
Valley City State University,
101 College St SW
Valley City, ND 58072
Fax: 701-845-7190
STUDENT INFORMATION:
Name: _______________________________________________________________________________
Last,
First,
Middle,
Former, (If Applicable)
Mailing Address: _______________________________________________________________________
Street
_______________________________________________________________________
City
State/Province
Zip
Country, if not USA
Current Telephone: ____________________________________________________________________
Social Security Number (Last 4 Digits): ______
Student ID: ___________________________________
Send
Send
(No. of copies)
(No. of copies)
Birth Date: _____ /_____ /___ __
__
(if known)
Praxis scores to the following recipient/address
North Dakota Education Standards and Practices Board
2718 Gateway Avenue
Suite 303
Bismarck, ND 58503-0585
Praxis scores to the following recipient/address
Recipient
Street
City
Send
(No. of copies)
State/Province
Zip
Country, if not USA
Praxis scores to me
STUDENT SIGNATURE (required):
DATE: ____ /____ /____