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Out Of City Proctor

Columbus State Community College Out Of City - Proctor Request Form
DISTANCE LEARNING (DL) STUDENT
  Students who are enrolled in CSCC DL courses and reside further than 45 miles from the nearest CSCC testing center must locate a testing site to have exams administered. It is the student's responsibility to contact the site to verify the receipt of your exams and to schedule a testing time that will meet your instructor's deadline.
Student Name      
Cougar ID Number      
Student Telephone Number      
Columbus State Email Address      
Semester Requested      
A new request must be submitted each semester.
SITE FOR EXAM(S) TO BE SENT TO
Name of Site      
Colleges/Universities prefered
Address      
City      
State      
Zip Code      
Contact Person/Test Proctor      
N/A is not an acceptable response.
Telephone      
E-mail address      
Does this site have internet access?
   
Have you notified your instructor(s) of your plans to test outside of the area?
   
Is your mailing address current at CSCC?
   
Will you be using this same location for all of your course exams this semester?
   
Is this site outside of the United States?
   
If yes, please enter the country name below.
Country      
Verify Your Address
Street      
City      
State      
Zip Code      
Instructors/Courses/Exams (Comments)