Request for Examination Review Form

Submitted by JCAttamack on Mon, 04/07/2025 - 11:50

Please complete this form to request to attend an NC Well Contractors Certification Examination Review.

Requests must be received at least 10 business days prior to the date of the examination review being requested, and within 12 months after the failed examination.

Applicants requesting an examination review must have an active application that allows registration at a future examination prior to application expiration.

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First Name

Last Name

Email Address

Examination Review Date

Exam Certification Level

Failed Examination Date

I have read, understand and completed this form.

Electronic Signature

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