Rio Salado College

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:

Comments:
I have read the proctoring guidelines*