ACCUPLACER Information

Please complete the following information to have the ACCUPLACER Computerized Placement exam username and password emailed to you once the examinee has paid for the ACCUPLACER exam to BSC.

A proctor is an individual from a college or university testing center or military education center. The proctor cannot be a personal friend, co-worker or relative. Exams must be administered at a business or public site. Exams may not be taken at the examinee or proctor's home.

* Indicates Required Field.
To ensure the timely processing of your form, please enter all of the necessary information.
* I agree to administer the ACCUPLACER Computerized Placement Exam to the following student:
 
Student Information:
* Student First Name:
 
* Student Last Name:
 
* Date of Birth (00/00/0000):
 
* Student BSC Email:
 
* Phone:
 
* I agree to verify identification of the student by use of a government issued ID (Driver's License, Passport, or Military ID.):
 
* I agree to maintain security and confidentiality of the ACCUPLACER Exam and of the student's scoring and personal information
 :
 
* I agree to maintain a quiet and secure testing environment:
 
* I agree to be present throughout the entire exam and ensure the student does not have access to any additional resources, besides scratch paper, while completing the exam:
 
* I agree that any proctoring fees must be charged directly to the examinee and not Bismarck State College:
 
Proctor Information:
* Proctor First Name:
 
* Proctor Last Name:
 
* Title:
 
* Proctor Work Email:
 
* Institution:
 
* Proctor Phone:
 
* Fax:
 
* Signature: I certify to the best of my knowledge that the information on this form is true and complete. By checking this box you have created an electronic signature as legal as your handwritten signature:
 
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