San Diego Community College District
3375 Camino Del Rio South
San Diego, California 92108
(FAXED FORMS WILL NOT BE ACCEPTED. DO NOT FAX)
Intersession
Spring
Summer
Fall
STUDENT/PROCTOR AGREEMENT FORM for PARTIALLY ONLINE CLASSES
AGREEMENT FORM RETURN DEADLINE: Forms are due by the due date specified by the instructor. Failure to correctly enter ALL
information below will result in exams not being sent.
5-Digit CRN #
Name Of Course Enrolled in
Name of Instructor
STUDENT AGREEMENT (Please print legibly)
As a student, I agree to the following:

To be responsible to locate a proctor and to set up an appointment to take my online or paper-based exam(s), according to the
required dates established by my instructor.

To verify that my proctor lists the mailing address of the educational institution, not a home address.

To be responsible for reimbursing the proctor for mailing expenses, where applicable.

To take either the online or the paper exams on date required by my instructor; and, in the case of paper exams, have my proctor
mail them to the instructor so they arrive by the assigned due date.
Student ID # ______________________________________
Student Name ___________________________________________
Email ___________________________________________________
Address ________________________________________________
Phone Number (_____)_____________________________________
City ____________________________________________________
State _____________ Zip Code ______________________________
Student Signature ________________________________________
Date ____________________________________________________
(By signing this form I, the student, agree and comply with San Diego Community College District policies and procedures)
http://studentweb.sdccd.edu
PROCTOR AGREEMENT (Please print legibly)
As a proctor, I agree to the following (Choose the one that applies)
I am a librarian, testing coordinator, administrator, or a teacher at a community college, university, elementary or secondary school.
I am a testing administrator or education services officer for the military.
NOTE: If the Proctor does not match one of the two choices above, this form will be denied
I also agree to the following:
I am not a current student at San Diego Community College District.

I will personally check the student’s identification and administer and supervise the indicated exam.

In the case of a paper exam, I will personally mail the complete exam back to the instructor immediately.

I will confirm with the student how the student will pay for the cost of returning the exam packet.
Proctor Name ________________________________________________ Title _____________________________________________________
Institution _____________________________________________________________________________________________________________
Address (at the institution) _______________________________________________________________________________________________
City ____________________________________________ State ________________________________ Zip Code _________________________
Email address (at the institution) __________________________________________________________________________________________
Phone Number: Employer’s (_____)______________________________ Proctor’s Daytime (_____)___________________________________
To protect the security and integrity of the exams and testing process, all paper exams must be mailed to the institution where the proctor
Is employed as an educator or military service officer.
Proctor Signature _____________________________________________ Date ____________________________________________________
(By signing this form I, the Proctor, agree and comply with San Diego Community College District policies and procedures)
http://studentweb.sdccd.edu
PLEASE KEEP A COPY FOR REFERENCE