CBE Proctored Test Request Form
Please complete the following information:
Items marked with an asterisk (*) are required, the request may
not
be processed or could be significantly
delayed
if this information is not included.
Student Information
Name*
Student ID*
(
Numeric keys only
)
E-mail Address*
(All communication will be conducted through official Maricopa email addresses only)
Address*
Are you registered with Disability Services?*
Yes
No
Proctor Information
Proctor Name:*
Proctor Title:*
Institution:*
Phone Number*
Email Address*
Address*
Credit by Exam
Course Number:
Department Permission Received*
Yes
No
Are you requesting a Law Enforcement Technology exam?
Yes
No
Current or Former Chief Administrator Name*
Department*
Rank/Position*
Phone Number*
Email Address*
Address*
Comments:
I have read the proctoring guidelines*
I understand that the proctoring process is offered to students who do not live in Maricopa County or will not be in Maricopa County during the time period of their exams. Students located in Maricopa County must test at a Rio Salado Testing Center.
The proctor I have located is employed at an accredited university, college or military base education center.
Rio Salado will work as quickly as possible to process my request but I understand the process can take up to 3 weeks to complete.
Rio Salado processes all requests in the order they are received. In order to be fair to all students, Rio Salado does not expedite requests.
I understand that in order to process my request in a timely manner, Rio Salado cannot estimate or guarantee an arrival date for exams.
All correspondence will be conducted through my official Maricopa Community College email address.
