telephone proctor request - Columbus State Community College

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Hours of Operation - Columbus Campus
Monday – Thursday 9:00 pm – 8:00 pm
Friday and Saturday 9:00 am – 4:30 pm
Sunday
12:00pm – 6:00pm
Academic tests are not administered one hour prior to closing.
College Testing Services – Testing Center
550 E Spring St
Aquinas Hall (AQ) 002
Columbus, Ohio 43216
614-287-2478 Phone 614-287-6096 Fax
C O LU M BU S S T A TE C OM M U NI TY C O LLE GE O U T
OF
C IT Y – P R OC T O R R E QU E ST F OR M
Testing Coordinator dloctest@cscc.edu
DISTANCE LEARNING (DL) STUDENT
Students who are enrolled in CSCC DL courses and reside outside of Central Ohio must locate a testing site to have exams
administered.* It is the student’s responsibility to contact the site to verify the receipt of your exams and to schedule a
testing time that will meet your instructor’s deadline.
Date:
Name:
Student ID number:
Telephone number:
CSCC e-mail address:
SITE FOR EXAM(S) TO BE SENT TO
Name of Site: **
Address:
City:
State:
Zip:
Contact Person:
Telephone:
E-mail address:
Does this site have Internet Access?
Yes
No
Have you notified your instructor(s) to have exams sent?
Is your mailing address current at CSCC?
What is your correct address?
Yes
Yes
No
No
Street
City
State
Zip Code
Instructors/Courses/Exams (Comments):
Date Received:
O F F I C E U S E O N L Y :
Received by (Initials):
*SITE SELECTED SHOULD HAVE STAFF THAT IS RESPONSIBLE FOR ADMINISTERING AND PROCTORING EXAMS AS A REGULAR DUTY.
**COLLEGES/UNIVERSITIES PREFERRED.
Revised 12/20/12
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