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ACM Placement Assessment - Remote Proctoring Form

The following information must be completed by the official agreeing to proctor the ACM placement test. The form must be submitted using a high school, college, or governmental email address. Please contact Mr. Jackson with at least a three day notice to allow time for setting up system.

Proctor's Name:

Proctor's Title:

Proctor's Institution:

City          Zip code: 

Phone Number:

Email Address:

Student's Legal Name:

Gender: Female  Male

Birth Date:

Date Test will be Administered: