LAC Proctor Submission Form - Formstack

Student Information

Student ID*

Cerro Coso, Bakersfield, and Porterville students, please enter your student ID with the initial @ sign. Students from other colleges, please enter the name of the college.

Student Name *

Student Email*

You must use your official @email.cerrocoso.edu (or BC or Porterville) student email address.

Student Phone*

Student Address

Address Line 1

Address Line 2

City

State

ZIP Code

Do you have any DSPS accommodations?*

Yes No

Please explain your DSPS accomodations

Course Information

Course Name*

Please include the department and number. For example MATH C055.

Course CRN *

This is a 5-digit number, beginning with 3, 5, or 7.

Proctor Information

Proctor Name*

If you are taking proctored exams at the Ridgecrest/IWV campus, fill in "Kelly Potten"

Proctor Email*

If you are taking proctored exams at the Ridgecrest/IWV campus, fill in "kelly.potten@cerrocoso.edu"

Proctor Position

Proctor Phone

If you are taking proctored exams at the Ridgecrest/IWV campus, fill in "760-384-6161"

Proctor Fax

Proctor Address

Address Line 1

Address Line 2

City

State

ZIP Code