ONLINE STUDENTS – DISTANCE LEARNING TESTING
Remote Test Site & Proctor Approval Form
This form is to be completed TWO WEEKS prior to week of testing ONLY by students outside of the
Hagerstown, MD area
Remote Site Approval: Location must be a college, university, military Educational Services Office or certified testing
center. No other locations will be approved. A new form is required for each semester.
Remote Proctor Approval:
Must be an employee affiliated with the school’s assessment/testing office or program and
authorized to administer exams on behalf of the appropriate institution.
Military Test Proctors:
Must be appointed or assigned to the Educational Services Office.
Fees:
Student is responsible for any fees charged by the remote test site.
STUDENTS MUST NOT SCHEDULE ANY EXAMS TO BE ADMINISITERED AT A REMOTE SITE UNTIL THIS FORM HAS BEEN
APPROVED BY HAGERSTOWN COMMUNITY COLLEGE
Semester:_____________________________________________________________________ Date:_____________________________________________
Student’s Name:_______________________________________________________________ Student’s HCC ID number:_________________________
Last First Middle Initial
Daytime Telephone Number:__________________________________________ Email Address:_____________________________________________
Course Name:______________________________ Course Number:__________________ Instructor:________________________________________
Course Name:______________________________ Course Number:__________________ Instructor:________________________________________
Course Name:______________________________ Course Number:__________________ Instructor:________________________________________
REMOTE TEST SITE INFORMATION
Remote Test Site:_____________________________________________________ Proctor’s Name:____________________________________________
Mailing Address:______________________________________________________ Proctor’s Title:_____________________________________________
______________________________________________________________________ Proctor’s Email:____________________________________________
______________________________________________________________________ Phone Number:____________________________________________
School Web Page Address:____________________________________________ FAX Number:______________________________________________
I hereby certify that I will administer exams under conditions required and requested by Hagerstown Community College.
___________________________________________________________ ___________________________________________________________
Proctor’s Printed Name Proctor’s Signature
THIS FORM WILL NOT BE ACCEPTED WITHOUT PROCTOR’S PRINTED NAME AND PROCTOR’S SIGNATURE.
Hagerstown Community College
HCC DLO SERVICES STAFF ONLY
Academic Testing Center Verified student’s registration
11400 Robinwood Dr Verified testing site
Hagerstown, MD 21742 Verified proctor’s name
TELEPHONE: 240-285-7495 Updated database – student, proctor, & site
FAX: 301-393-3689 Date verified & updated____________________
EMAIL: testingcenter@hagerstowncc.edu
Staff initials________________________________
