GED Testing Program
200 Maroon Tide Drive
Galax, VA 24333
Date: ______________________________________________________
Name: _____________________________________________________
Social Security No.: __________________________________________
Date of Birth: _______________________________________________
Date of Test: ________________________________________________
Mailing Address: _____________________________________________
_____________________________________________
City, State, Zip Code: _________________________________________
Day Telephone No.: __________________________________________
___________________________________________________________
Applicant's Signature
Mrs. M-L Cruey
Chief GED Examiner
Galax High School
200 Maroon Tide Dr.
Galax, VA 24333
(276) 236-2991