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Community Outreach Proctoring Request

NON-Columbus State Community College Student
This request is for the Columbus Campus or Dublin Campus
 

1) A separate form is required for each course requiring Community Proctoring if a different instructor | contact is involved.
2) Click here to schedule your appointment online.
3) Students will be responsible for payment of the proctoring fee. The Proctoring fee is $43.50 payable online with RegisterBlast.  NOTE:  A rush fee of $5 extra will be added if you need to take the exam within 48 business hours.

Please complete all the information below
Last Name      
First Name      
Middle Initial      
 
  Mailing Address:
Street      
City      
State      
Zip Code      
 
Home Phone      
Alt Phone (ex: cell)      
 
E-mail      
 
Please select the best method of contact:

   
 
*A New Request must be submitted each semester or term this service is needed.
SELECT YOUR PROCTOR SITE
  Please choose campus
Which CSCC Campus will you be testing at?
   
YOUR COLLEGE/UNIVERSITY ATTENDING:
College/University Name      
 
  School Address:
Street      
City      
State      
Zip Code      
 
  Contact Person:
Name      
Phone      
E-mail      
 
Is this an academic exam or a placement exam?      
Course Names(s) & Number(s)      
Exam(s):      
Exam submitted as:

   
Deadline Date(s):      
Comments
Enter comments about your exam (if any)