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

Student ID* (Numeric keys only)
E-mail Address* (Rio Salado Testing will conduct all communication through your official Maricopa e-mail address only)

Are you registered with Disability Services?*   Yes     No

Proctor Information

Proctor Name:*
Proctor Title:*
Phone Number*
Email Address*


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: 7156 (example)
Course Number: Section Number:

I have read the proctoring guidelines*