Proctor Information Form

The information requested below will be used to qualify your examination proctor. Read the Exam Process document before contacting the individuals you list, so that you can explain what is required of an official and a substitute proctor to enable the individuals to make an informed choice about their willingness to commit to this responsibility.

Student Contact Information
Last Name		First Name		M.I.

Preferred Name or Nickname		Title (Mr./Mrs./Ms.)
Primary Email Address	*UNCC Email Address	2nd Email Address
Daytime Phone		2nd Phone
Fax Number

NOTE: Your permanent address that is listed in the university's BANNER system will be used to mail items to you. Please ensure that it is current.

Place of Employment
Department		Work Phone
Address
City	State		Zip

Proctor Contact Information
Last Name		First Name		M.I.

Proctor's Name or Nickname		Title (Mr./Mrs./Ms.)
Primary Email Address		2nd Email Address
Daytime Phone		2nd Phone
Will you be able to fax tests to the DE Office?	YesNo	Fax Number

Preferred Address to receive test materials. Examination packets are sent by UPS and a street address is required. Please fill in all that applies.
Name of Company
Address		Home Address	Yes No
Department
City	State	Zip

Mailing Address to receive letters. A Post Office Box may be used.
Address		Home Address	Yes No
Department
City	State	Zip

Mailings are only sent to the Official Proctor's address.
Substitute Proctor's Complete Name
Daytime Phone		Email Address
Will you be able to fax tests to the DE Office?	YesNo	Fax Number

Contact Information

Toll-free Fax: 1.866.828.0275
Local Fax: 704.687.4305