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Proctor Request Form for LCC Online Learning Students

The Online Testing Support Office requires seven to ten businesses days to process a request. You will receive an email notification once your request is processed.

Please verify with your instructor to determine if your exams must be proctored.

Please go to www.lcc.edu/assessment/off_campus/FAQ.aspx for additional information.

Student Information

(* Denotes a required field)

Are you a current LCC online student who is requesting to test off-campus?
Yes
No

*Student Name

*Student # SS#'s are not accepted.

*Birth Date

*Student Telephone

*Student Address

*Student City

*Student State

Country, State or Province

*Student Zip/Postal code

*LCC Student Email Address
Click for help accessing your LCC email account

*Verify Email Address

*Semester Attending

Please list all on-line courses and instructors that you will be enrolled in this semester.

*Courses

*Instructors

Proctor Information

*Proctor Name

*Proctor Location

*Proctor Address

*Proctor City

*Proctor State

Country, State or Province: .

*Proctor Zip/Postal code

*Proctor Email

*Verify Proctor Email

*Proctor Telephone

Proctor Fax

*Have you used this proctor location in previous semesters? If yes, what semester?

*Do you know the proctor on a personal or professional basis?

Yes No

If yes, Please explain.

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. You will receive an email notification once your request is processed.

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

If you have any questions or concerns, please contact our office at:

1-800-644-4522 x5503 or by email at lcc_online_testing@lcc.edu

form r2.0

Assessment Center at Lansing Community College

Assessment Center
Course Testing - TLC 104

Placement Testing - GB StarZone
Phone: (517) 267-5500
Additional contact information »

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