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Outside Proctor Request Form

Before filling out this form please review the Guidelines for Setting up a Proctor

General Information ( * Denotes a required field)

*Are you a student from an outside institution, not LCC, and need LCC to proctor for you?     Yes No

*Have we proctored for you before?  Yes No

If yes, when and for what institution?

*Do you know any of the staff at our testing facility on a personal basis?
Yes No

If Yes, please explain:

*Please complete the following information.(Be as specific as is necessary to avoid delays in your request):

Student Information

*Student Name      

*Birth Date                 

*Student Telephone     

*Student Address      

*Student City  

*Student State  

Country, State or Province:  . 

*Student Zip/Postal code    

 *Email Address            

*Verify Email Address    

Educational Institution Information

*Contact person at institution:      

*Contact person telephone:   

Contact Person Fax: 

*Institution Name:      

Institution Address: 

Institution City: 

Institution State: 

Country, State or Province:

Educational Institution Zip/Postal code: 

*Contact Person Email Address:
 

*Verify Contact Person Email Address:
 

Do you require special testing accommodations, if so please explain. (Please note that documentation may need to be provided for your request)

Other Comments

ATTENTION:

The Online Testing Support Office will not process your request, unless the form is complete.

The Online Testing Support Office requires seven to ten businesses days to process a request.

For additional information, please visit our website at www.lcc.edu/assessment/

If you have any questions or concerns, please contact Patricia (Torey) Griffith at:
517-267-5519 or by email at lcc_proctoringservices@lcc.edu

              

Assessment Center at Lansing Community College

Assessment Center
TLC Bldg, Room 104
Phone: (517) 267-5500
Additional contact information »

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