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Assessment Center Registration Form
 
Please use this form to register your school, agency or business as a Florida Ready to Work Assessment Center. An organization may have multiple Assessment Center locations. Please submit a separate form for each Assessment Center. Upon receipt of the form, the Primary Contact will be contacted by a Florida Ready to Work Project Coordinator to verify registration as a Florida Ready to Work Assessment Center within 2 business days.
Note: * equals Required Fields.
 
Click the "What Is This?" icon for additional information about a particular field.
 
Assessment Center Information
Physical Location of program delivering FRW assessments, as appears on signage or how the program is best known. This is how the Assessment Center will be listed on the FRW website.
 
Assessment Center Name: *
Physical Address: *
City: *
State: *
Zip: *
County: *
Type: *
Population: *
Telephone: *
Telephone Extension:
Website:
   
Primary Contact
The Primary Contact is the person who is responsible for the implementation of the FRW program and delivery of the FRW Assessments at this Assessment Center.
 
First Name: *
Last Name: *
Title: *
Mailing Address: *
City: *
State: *
Zip: *
Telephone: *
Telephone Extension:
Email: *
   
Alternate Contact (Optional)
First Name:
Last Name:
Title:
Telephone:
Telephone Extension:
Email:
   
Credential Delivery Information
Delivered To: *
   
Credential Contact
The Credential Contact is the person to whom the FRW Credentials will be mailed if Credentials are NOT mailed to the student/jobseeker address.
** If mail to student/jobseeker address is chosen, a Credential Contact is still required in the case of an undeliverable student/jobseeker address or other Credential matter.
 
First Name: *
Last Name: *
Title:
Additional Routing Info:
Mailing Address: *
City: *
State: *
Zip: *
Telephone: *
Telephone Extension:
Email: *
   
Notes
Please supply additional information here or include any questions you may have.
 
Notes:
     
  Note: * equals Required Fields.
 

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