Proctored Test Request Form

Please complete the following information:
Items marked with an asterisk (*) are required and your request may not be processed or may be significantly delayed if they are not included.

Student Information

Name*

Student ID*

(Numeric keys only)

Phone*

E-mail Address*

(Rio Salado Testing will conduct all communication through your official Maricopa e-mail address only)

Address*

Are you registered with Disability Services?* Yes No

Proctor Information

Proctor Name:*

Proctor Title:*

Institution:*

Phone Number*

Email Address*

Address*

Classes*

Are you requesting a Placement Exam? Yes No

(If you require a placement exam only, please type 'N/A' in course number and section number)

Course Number:	EDU 240 (example)	Section Number:	12345 (example)
Course Number:	Section Number:	Exam Due Date:
Course Number:	Section Number:	Exam Due Date:
Course Number:	Section Number:	Exam Due Date:
Course Number:	Section Number:	Exam Due Date:

Comments:

I have read the proctoring guidelines* Yes

	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.