| Test Proctor Submission Form |
| Purpose of Form |
*
Students will use this form to notify the Central Texas College Testing
Office of the location and contact information for the student's chosen
test proctor. CTC does not maintain a list of test proctors; it is up
to the student to locate a suitable proctor. For military students,
you should check with the education center, testing center, library,
or learning centers. For other students, you can find a proctor at a
local college, a library, a high school, or other suitable facility.
Central Campus students in the Killeen
area do not need to fill out this form. |
| Student
Information |
Complete
the information below about yourself. Please fill in all fields. |
| Name |
First |
Last |
| Social Security Number* |
Enter the last 5
digits of your SSN in this format #####
*
This information will be protected in transit and is needed to identify
the student in our student information system. |
| Phone Number |
Include the Area Code
|
| Email |
Email |
| Course Name & Instructor |
Enter your first course alphanumeric.
(example MATH 1314) |
Select course format. |
Enter the name of your instructor.
(example John Smith) |
Date course starts.
(example 01/14/02) |
| Course Name & Instructor |
Enter your second course alphanumeric.
(example MATH 1314) |
Select course format. |
Enter
the name of your second instructor.
(example John Smith) |
Date
course starts.
(example 01/14/02) |
| Test Proctor
Information |
Complete
the information below about your chosen test site and your test proctor.
If you are not sure how to find a proctor, refer to the requirements
for testing web page or send
us an email. |
| Testing Site |
Where you will go to take the test. (example: Hays High
School) |
| Site Address |
Street Number and Address (example: 1501 North Main
Street) |
| Site City, State, Zip Code |
City |
State |
Zip Code |
| Test Proctor Name |
First |
Last |
Position/Job Title/Military
Rank |
| Proctor Phone Number and Fax |
Phone number. Include Area code |
Fax number. Include Area Code |
| Proctor Email |
Email
Personal email addresses such as; yahoo, hotmail, or gmail cannot be used. |
*Bachelors Degree obtained from |
If you have problems with this form,
call 800-792-3348 ext. 1441, 1501, or 1289. |
Comments |
| All items in red are required. If this information is not filled out the Proctor will not be approved.
|