Name or invoice No.
	E-Mail Address
	Date of test
	State in which test was taken
	Level	Bachelors  Masters  Clinical
	SWES programs used (More than one choice is possible)	SWES Lecture Progams  SWES Review Books  SWES Autotest Software
		Pass  Fail
	License Test Score
	Estimated number of hours you studied with the SWES Guides/Software
	Comments