Internal Trainer Request for Exam Codes and/or Request to ProctorIf you are an External KCS v6 Trainer, please request exam codes or proctor setup here.Internal Trainer Request to Proctor/Exam Codes Name* First Last Email* What do you need help with?*Please choose one.Set up an exam to proctor in personReceive coupon codes to distribute to attendees taking the exam on their ownEmail Address to use as a Proctor in Webassessor*This can not be the same as the address you used as a test taker in Webassessor. Phone you can be reached at while proctoring:*Exam you are requesting to proctor:*Applicable discounts apply to KCS Practices Exam and Practice Test(see below) Trainer exam will be invoiced at list price.KCS v6 Practices ($450 list price)KCS v6 Trainer ($650 list price)KCS v6 Practices RETAKE ($170 list price)Include the practice test ($85 list price)*(Applicable discounts apply - see below) Yes NoDate the exam will be administered:* MM slash DD slash YYYY Maximum number of students taking the exam:*Name of exam location:*Address of the exam location:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Approximate time the exam will be started:*Exam location time zone:*Percent Discount your company receivesDiscount below reflects the discount you receive for proctoring as well as your Consortium member level discount. 15% - Consortium non member 20% - Participant 25% - Participant Plus 30% - Sponsor 35% - BenefactorNotes:Any additional notes you would like the KCS Academy to know By submitting this form, you agree 1) you are responsible for distributing the codes 2) and to be invoiced at list price less the applicable discount.Exam you are requesting codes for:*KCS v6 Practices ($450 list price)KCS Trainer ($650 list price)Include the practice test ($85 list price)*(Applicable discounts apply - see below) Yes NoApproximate date of associated workshop:* MM slash DD slash YYYY Last day to register for the exam:*Please enter the date that a student must register for the exam by. (Best practice - last day of the month of the workshop or 30 days from workshop) MM slash DD slash YYYY Last day the exam can be taken:*Please enter the date a student must complete the exam by. (Best Practice - within 60 days of workshop) MM slash DD slash YYYY Approximate number of coupon codes needed:*You will only be charged for coupon codes used.Percent Discount your company receives*Discount below reflect the discount your company receives based on your Consortium member level. 5% - Consortium Non-member 10% - Participant 15% - Participant Plus 20% - Sponsor 25% - BenefactorNotes:Any additional notes you would like the KCS Academy to know By submitting this form, you agree 1) you are responsible for distributing the codes, 2) to communicate Kryterion reschedule/cancellation policy, and 3) to be invoiced at list price less the applicable discount. PhoneThis field is for validation purposes and should be left unchanged.