Proctor Request Form for LCC Online Learning Students
All LCC online learning students who reside 60 miles from LCC’S main campus Assessment Center are eligible to test off-campus.
Students who request to test at the Livingston County Center, and do not meet the 60-mile requirement will be charged a $15 per test fee.
Please verify with your instructor to determine if your exams must be proctored.
Please go to http://www.lcc.edu/assessment/off_campus/FAQ.htm for additional information.
Student Information ( * Denotes a required field)
Are you a current LCC online student who is requesting to test off-campus? Yes No
*Student Name
*Student # SS#'s are not accepted.
*Birth Date January Febuary March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
*Student Telephone
*Student Address
*Student City
*Student State International Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New York New Hampshire New Mexico North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Wisconsin West Virginia Wyoming
Note: If you are using an international address please select "International" as your Student State. Then type in your Country, State or Province below.
Country, State or Province:
*Student Zip/Postal code
*Email Address
*Verify Email Address
*Semester Attending: Spring 2008 Summer 2008 Fall 2008 Spring 2009 Summer 2009 Fall 2009 Spring 2010 Summer 2010 Fall 2010
Please list all on-line courses and instructors that you will be enrolled in this semester.
*Courses
*Instructors
Proctor Information
*Proctor Name (What's this?)
*Proctor Location
*Proctor Address
*Proctor City
*Proctor State International Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New York New Hampshire New Mexico North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Wisconsin West Virginia Wyoming
Note: If you are using an international address please select "International" as your Proctor State. Then type in your Country, State or Province below.
*Proctor Zip
*Proctor Email
*Verify Proctor Email
*Proctor Telephone
*Proctor Fax
*Have you used this proctor location in previous semesters? If yes, what semester?
If your proctor charges a fee please list their fee in the box below
*Do you know the proctor on a personal or professional basis? Yes No
If yes, Please explain.
*Please provide the title of your online learning course(s)
Do you require special testing accommodations, if so please explain. (Please note that documentation may need to be provided for your request)
Other Comments
ATTENTION:
The Online Testing Support Office will not process your request, unless the form is complete.
The Online Testing Support Office requires seven to ten businesses days to process a request. You will receive an email notification once your request is processed.
For additional information, please visit our website at www.lcc.edu/assessment
If you have any questions or concerns, please contact our office at:
1-800-644-4522 x5503 or by email at lcc_online_testing@lcc.edu
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Hours and Location
