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Fundamental Use of Surgical Energy (FUSE)

A SAGES Fundamentals Program

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FUSE Webassessor Info Form

FUSE Webassessor Info Form

Information collected here will be used to activate FUSE approved Test Centers in Webassessor

Select an option from the drop down menu below*
Name of FUSE Proctor filling out this form*
First Last
Email of FUSE Proctor filling out this form*
FUSE Test Center Name*
Enter the name of your program/institution as it currently appears in Webassessor*
Do you need to update your program/institution name in Webassessor?*
- Yes
- No
Enter the new name of your program/institution*
Academic Affiliate*
If applicable
Test Center Main Contact*
First Last
Do you need to update your Main Contact Information in Webassessor?*
- Yes
- No
New Main Contact*
First Last
Main Contact Email*
Do you need to update your Main Contact's email address?*
- Yes
- No
New Main Contact email*
Main Contact Phone Number*
Do you need to update your Main Contact's phone number?*
- Yes
- No
New Main Contact Phone Number*
Testing Center Country*
- United States
- Canada
Address (This is where FUSE Testing will be taking place)*
Street Address Address Line 2 City State ZIP Code
Address (This is where FUSE Testing will be taking place)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you need to update your program/institution address in Webasessor?*
- Yes
- No
New Address - Please note that any changes to the address of your program/institution's address will need to be approved by the SAGES office by providing/emailing images of your new FUSE Testing space*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Important Location Information*
Any necessary logistical information not listed in Address line 2 to ensure the test-taker arrives in the correct location (parking garage location, turn by turn directions from the main lobby, phone number to call upon arrival, link to a campus map)
Do you need to update your Important Location Information?
- Yes
- No
New Location Information - Please note that depending on the changes to your program/institution's location information you may need to provide/email images of your new FUSE Testing space to the SAGES office for approval*
Any necessary logistical information not listed in Address to ensure the test-taker arrives in the correct location (parking garage location, turn by turn directions from the main lobby, phone number to call upon arrival, link to a campus map)
Phone
This field is for validation purposes and should be left unchanged.

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