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									                                         2011 TEAS V REGISTRATION FORM
The TEAS V will be administered at North Central State College in Kee Hall, Room 123, on the following dates. Please follow the
steps below to register with ATI and reserve your seat. Submit your registration early as seats are LIMITED!
                        CHECK ONE TEST DATE - Please complete ONE form for each test date.
          Morning Test Times               Start Time End Time                  Afternoon Test Times                Start Time End Time
                                                                         Monday, June 27, 2011                      3:30 PM       7:30 PM
    Thursday, July 14, 2011                9:30 AM 1:30 PM               Wednesday, August 03, 2011                 1:00 PM       5:00 PM
    Thursday, August 25, 2011              9:30 AM 1:30 PM               Wednesday, September 21, 2011              1:00 PM       5:00 PM
    Thursday, September 08, 2011           9:30 AM 1:30 PM               Wednesday, October 05, 2011                1:00 PM       5:00 PM

                                                      Registration Fees
                                               Non-Refundable fee of $50.00

                    Follow these steps to register and pay for your TEAS V Test.

  1 Visit           and click on "Create an Account" (unless you already have
    an account with ATI). This mandatory registration will allow you to test and retrieve your results.
  2 Indicate your test date by checking the appropriate date above. Keep in mind space is limited.
  3 Complete your personal information below.
  4 Take this form along with your cash, check, money order, or credit card to the Cashier's Office in
  5 Check your NC student e-mail account for reminder notices regarding your test date.
  6 Please bring a form of identification with you on the test day to Kee Hall, Room 123. Suggested
             If you cannot attend on the date indicated, you must notify the Student Success Center at
     419-755-4764 at least 7 DAYS in advance of your scheduled test date to reschedule; otherwise, another non-
                                             refundable fee will apply.

Name                                                                      Student ID or Social Security Number

                                                                         (         )
Address (House number and Street)                                        Area Code          Telephone No.

City, State Zip Code                                                    Student Email Address
                                                        (ALL email will be sent to NC student email account when possible)

                                                                               This form and check can be mailed to:
                                                                                          Cashier's Office
Note: Students who wish to prepare for the TEAS V test may                           North Central State College
checkout a copy of the TEAS V Study Guide at the Bromfield                             2441 Kenwood Circle
Library or work with a tutor (free of charge!) in the Tutoring                              P.O. Box 698
               Center in Fallerius, room 119.                                        Mansfield, OH 44901-0698

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