BCCC Distance Learning - Test Proctor Form

Bucks County Community College
Test Proctor Form for Online Learning

This form is used for online learning courses in which a proctored test is required and Bucks County Community College testing facilities are otherwise inaccessible to the student. The form is a proposal from the student to the instructor for a testing environment that meets the faculty member's requirements. The instructor may approve or disapprove this proposal based upon the instructor's assessment of this proposal's information.

A proctor is an individual who agrees to receive the tests from the student's instructor, administer them in an approved environment and return them to the instructor. The proctor must verify that the student completed the test according to the specific directions of the instructor. Examples of individuals who may be eligible to serve as proctors are:

College or university personnel such as deans, department chairs, professors, librarians, or testing center personnel.
Public or private school personnel such as superintendents, principals, guidance counselors, teachers.
Other personnel such as civil service examiners, military officers, or Sylvan Learning Center personnel.

Relatives and friends, regardless of their position, are not permitted to act as proctors.

The student is responsible for sending this completed proposal to the faculty member in sufficient advance time for adequate consideration. Proposals may be mailed to the instructor c/o of Bucks County Community College, 275 Swamp Road, Newtown, Pa. 18940, faxed to the department's fax number, or faxed to the Online Learning Office (215-968-8148).

Course Title:
Name of Instructor:
Name of Student:
Student's Address:


Phone Number:
Email Address:
Time period for which this proposal is made (semester or specific dates):
Reason for Request:

Name of Person proposed as a proctor:

Title of Person or official capacity that would authorize use as a proctor:

Address of proposed proctor (for mailing of any test materials):

Fax # (if available for faxing test materials):

This section to be completed by proposed proctor:

I attest that I can and will provide an appropriately secure environment for this student to complete the designated examinations for this course and will abide by the instructions of the instructor. I further attest that I will retain the confidentiality of this examination from all persons except the instructor and will return the examination strictly according to the instructions provided by the instructor.

Signature:
Date:
Daytime telephone number:
Email address:

Name of Person proposed as a proctor:
Title of Person or official capacity that would authorize use as a proctor:
Address of proposed proctor (for mailing of any test materials):


Fax # (if available for faxing test materials):

Bucks County Community College Test Proctor Form for Online Learning

Bucks County Community College
Test Proctor Form for Online Learning