The information gathered here is used
only for administrative purposes
Please fill in all of the required (italicized) fields. This information is
used to deal with a number of important issues: fingerprints sometimes
must be retaken, there may be scheduling issues, billing problems, and the like.
Some of the information is used to differentiate people with the same name.
Not having the information that will allow us to accurately identify you or verify
scheduling or billing information can cause delays or unnecessary costs to you
or your organization.