Fillable Alternate Proctor Location Student Request Form and Instructions (Lord Fairfax Community College)

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Alternate Proctor Location Student Request Form and Instructions (Lord Fairfax Community College)

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Alternate Proctor Location
Student Request Form and Instructions
Revised January 2020
Students are expected to take proctored exams at a LFCC testing center. Students who
cannot travel to one of the LFCC testing centers may request to have their exam
proctored at another testing location. Requests for proctored exams at a non-LFCC testing
site must be approved by the LFCC course instructor. Below are the steps to request a
proctored exam at a non-LFCC location:
1. Contact the course instructor outlining the reason for your request to have a test
proctored at an alternate testing location and where you are requesting to test.
2. If the faculty member approves the request, complete section 1) STUDENT AND
COURSE INFORMATION and submit the form to a proctor at the alternate testing
location.
3. The proctor at the alternate testing location completes Section 2) PROCTOR
INFORMATION and submits the completed form to LFCC’s testing center.
4. LFCC’s testing center contacts the course instructor to verify permission and
processes the request. Once the request has been processed and the test has
been submitted to the alternate location, the student is notified.
A Few Things to Keep in Mind
Students are expected to adhere to the policies and procedures of both LFCC and the
alternate testing location.
Submit one form for each course.
This is not a quick process. As soon as you know you cannot test at a LFCC testing
center, please contact your instructor about testing at an alternate location.
At LFCC, please allow up to 5 business days for processing. To check the status of a
request, call 1-540-868-7140 or email lftesting@LFCC.EDU.
It may take the alternate testing location several days to process the request.
Alternate Proctor Location
Student Request Form and Instructions
Revised January 2020
Section 1) STUDENT AND COURSE INFORMATION (Student: Please print or type.)
DATE: ___________________________ LFCC STUDENT ID#: ________________________________
LAST NAME: ______________________________ FIRST: _________________________ MI: _______
STUDENT EMAIL: ______________________________________________@EMAIL.VCCS.EDU
STREET: ________________________________ CITY: ________________ STATE: _____ ZIP: _______
PHONE # CELL: (______) _______________________ HOME: (______) _________________________
COURSE: _____________________________________________SECTION#: ______________________
INSTRUCTOR: _________________________________________________________________________
ALL EXAMS FOR SEMESTER OR SPECIFIC EXAM TITLE: _____________________________________
REASON FOR REQUESTING A PROCTOR: _________________________________________________
______________________________________________________________________________________
STUDENT SIGNATURE: _________________________________________________________________
Section 2) PROCTOR INFORMATION (Proctor: Please print or type.)
PROCTOR: Please include the following proctor information, signed and dated:
I agree to serve as a proctor for __________________________________________. I will adhere to the
test instructions received from LFCC. I certify that the information I provided on the Alternate Location
Proctor Request Form is correct.
PROCTOR'S LAST NAME: _________________________ FIRST: _____________________ MI: ______
TITLE: __________________________________ ORGANIZATION: _______________________________
STREET: ___________________________ CITY: _________________ STATE: _____ ZIP: ________
COUNTRY IF NOT U.S.: _______________________ WORK PHONE: (______) ____________________
EMAIL ADDRESS: ______________________________________________________________________
PROCTOR SIGNATURE: ________________________________________________________________
Please email this completed form to lftesting@lfcc.edu with Subject: Alternate Proctor Request.
Lord Fairfax Testing Center
Lord Fairfax Community College
173 Skirmisher Lane, Middletown, VA 22645
540-868-7140
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Alternate Proctor Location Student Request Form and Instructions (Lord Fairfax Community College)

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Completed 27 July 2020

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