1.

Company Information
The following information refers to the company that is applying to become a Pearson VUE® Authorized Test
Center. The company must be in operation for a minimum of 12 months.

We have reviewed the Technical Requirements, Facility Requirements and Photo/Video Checklist and confirm
our test center meets the required specifications. *

Yes

Company name: *
Greenfield Education Pvt Ltd

Registered legal name: *

Greenfield Education Pvt Ltd
You will be asked to submit proof of your registered status when you submit your photos.

Date established: * 07 26 2013

Month Day Year

Address: *

#656/D, 16th Main,5th Cross, Above Iyengars bakery

Street Address

Street Address Line 2

Mysuru Karnataka
City State / Province

570009 India
Postal / Zip Code Country

Phone number: *

9591343563
Must be a land line. Include as appropriate: country code, area code, extension.

Fax number:

Website URL: *
http://www.mygtrac.com
Website must have been established for at least one year.

If your company forms part of a group, chain or franchise, please provide the name:

Please list your business locations.

Mysore, karnataka, India

2. Testing and Training Information

Which training programs do you offer? *

Adobe

VMware

LPI

Microsoft

Oracle

CompTIA

Cisco

NA

Other

What authorized learning partner programs do you belong to? *

Microsoft Learning Partner (MLP)

Microsoft IT Academy (ITA)

Cisco

Adobe

Oracle
VMware

CompTIA
LPI

None

Other

Please provide a Microsoft Partner Network (MPN) Organization ID, if applicable:

Please provide a Microsoft Partner Network (MPN) Location ID, if applicable:

Do you offer IT training as part of a degree program? *

No
Yes

Do you include certification exams as part of your training programs *

No
Yes

Do you offer? *

Instructor-led training
Online training

Both
NA

What vendor(s) do you currently use for curriculum?

What other services do you offer with your training programs? *

Practice tests
Lab simulations

E-books
Help with jobs/career tracks

NA

Do you currently offer computer-based testing with any other provider? *

No
Yes

What is your average training/testing volume per month?

How will the test administrator monitor individuals while they are testing? *

Direct line of sight into the testing room

Video cameras and monitors

Other

3. Contact Information
In order to ensure efficient communication by our teams to the appropriate individuals all contact information
is required, but the same person can be used for multiple contacts. There must be at least two contact
names. Each contact person needs to have a separate business email address.

Main Contact
(All application correspondence will be sent to this email address)
Main contact name: *

Ajay Kumar HS
First Name Last Name

E-mail address: *

ajay495@gmail.com
Must be a business email address. A confirmation email will be sent to this address upon completion of the application.

Phone number: *

08214255066
Must be a land line. Include as appropriate: country code, area code, extension.

Mobile number:

9731622442

Agreement Contact
(Must be authorized to sign agreements on behalf of your company.)

Authorized signer name: *

Ajay Kumar HS
First name Last name

Email address: *
ajay495@gmail.com
Must be a business email address. A confirmation email will be sent to this address upon completion of the application.

Phone number: *

0804255066
Must be a land line. Include as appropriate: country code, area code, extension.

Mobile number:

9731622442

Onsite Technical/Installation Contact:

(Must be available onsite to install the Pearson VUE System.)

Onsite technical/installation contact name: *

Mithun Kumar
First name Last name

Email address: *

info@mygtrac.com
Must be a business email address.

Phone number: *

08214255066
Must be a land line. Include as appropriate: country code, area code, extension.
Mobile number:

9980676606

Testing Administrator Contact/Proctor Contact

(Cannot have or be studying toward a Cisco Certification. Also advisable that this person speak English.)

Testing Administrator contact/Proctor contact Name: *

Shankar M
First name Last name

Email address: *

info@mygtrac.com
Must be a business email address.

Phone number: *

08214255066
Must be a land line. Include as appropriate: country code, area code, extension.

Mobile number:

9591343563

Purchasing/Curriculum Manager
(The individual who will organize the training curriculum and or purchase testing vouchers for your center.)

Purchasing/Curriculum Manager Name: *

Ajay Kumarf HS
First Name Last Name

E-mail address: *

ajay495@gmail.com

Phone number: *

08214255066

Mobile number:

9731622442

5. Photos/Video Submission

• If your photos/videos are not ready, go to the end of the application, Print a copy for yourself, then
click Submit. You will receive a confirmation email that contains a URL for submitting the photos/videos at a
later time. You may submit either photos, videos, or a combination of both - whatever is easiest for you.

• If one video illustrates all aspects of your test center, submit one file under Video - Other.

• If your photos/videos are ready, upload your files below.

• The application is not considered complete until photos/videos have been submitted.
• Preferred photo formats: .jpg, jpeg, png, gif, pdf. Also acceptable: doc, docx, xls, xlsx.

• Acceptable video formats: mpg, flv, avi, mov, mp4.

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Provide proof of business.

Choose File No file chosen
This must show that the business has been established for a minimum of one year.

Photo - Floorplan

Upload Floorplan Photo(s)

Video - Floorplan
Choose File No file chosen

Photo - Test Administrator's Position

Upload TA's Position Photo(s)

Video - Test Administrator's Position

Choose File No file chosen

Photo - Test Administration Area View

Upload TA View Photo(s)

Video - Test Administration Area View

Choose File No file chosen

Photo - Test Delivery Area

Upload Test Delivery Area

Photo(s)

Video - Test Delivery Area

Choose File No file chosen

How many workstations are in your testing room? *

Photo - Building Exterior

Upload Building Exterior

Photo(s)

Video of Building Exterior

Choose File No file chosen

Photo - Reception and Check-in Area

Upload Reception & Check-in

Area Photo(s)

Video of Reception and Check-in Area

Choose File No file chosen

Photo - Neutral background at Reception and Check-in Area

Upload Neutral Background

Photo(s)

Video of Neutral background at Reception and Check-in Area

Choose File No file chosen

Photo - Lockable Area

Upload Lockable Area Photo(s)

Video of Lockable Area

Choose File No file chosen

Photo - Other
 Upload Other Photo(s)

Video - Other
Choose File No file chosen
If there is an additional video or if there is one video for all of the required areas mentioned above upload it here.

Will you have a separate room or area available and equipped with a test delivery workstation that can
accommodate testing candidates with disabilities? *

Yes (please provide a photo)

No

“By submitting this Application Form, I represent that (i) neither I nor my Company are affiliated with a
Pearson VUE Authorized Test Center that was terminated by NCS Pearson, Inc or an affiliated company
(“Pearson VUE”) for cause; and (ii) the information contained in this application is true and accurate to the
best of my knowledge. In the event that Pearson VUE has reason to believe that I or my Company have
breached one or more of these representations, it shall be cause for immediate termination of any applicable
Pearson VUE Authorized Test Center Agreement with Pearson VUE.” *

Agreed