PROCTOR ACCEPTANCE FORM - Workforce Development
[Pages:1]PROCTOR ACCEPTANCE FORM
TO BE COMPLETED BY THE PROCTOR: Complete mailing address for examination: (Include apt. #, business name, etc.) Please print clearly:
Name ____________________________________________________________________________ Complete Mailing Address _______________________________________________________________
_______________________________________________________________
City _____________________________________________ State___________ Zip_______________ Phone Number __(___________)_________________ Email Address ___________________________
As a proctor I agree to:
? Verify contents of exam package and secure exams until day of testing ? Contact student to schedule testing when I have received the exams. ? Administer exam within 3 weeks of receipt of proctor exam package. ? Document identification of student at time of exam. ? Supervise student during scheduled exam. ? Adhere to time limits and complete verification of time on folder. ? Return all original exams and answer sheets to proctor department within 48 HOURS after exam is completed.
I understand and agree to carry out the proctor responsibilities. I certify that I am not related to the student.
Proctor Signature _________________________________________________ Date________________
Educational Background: (List highest degree achieved)
College
City/State
Year Graduated
Type of Degree
Major
__________________ _________________________ _________ ____________ ____________
FAX to 570-961-4169 or email to proctoracceptance@pennfoster.edu and include "Proctor Form" in subject line.
TO BE COMPLETED BY THE STUDENT: I have briefly explained what is expected of a proctor and certify that the candidate listed above is not related to me. Student Signature and Date ________________________________________________________________
Student ID Number _________________________________________________________________________
Student Address _________________________________________________________________________
Student Name ___________________________________________________________________________
PAF01
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