Orange Lutheran Online Proctor Certification Form
Student LAST Name *
Your answer
Student FIRST Name *
Your answer
Proctor Information
Eligible Proctors:
Academic or Guidance Counselor
School Administrator (Registrar, Secretary, Administrative Assistant, etc.)
Secondary Education Teacher
School Principal or Vice Principal
Librarian
Other Education Professional
Local Testing Center Administration
Proctor's Name *
First and Last
Your answer
Proctor Position/Job Title *
Proctor Phone Number *
(include area code)
Your answer
Proctor's School or Organization Name *
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Proctor Email *
Your answer
The Proctor is: *
If the proctor is related to the student what is the relationship
Your answer
Course Name (1) *
Your answer
Course (1) Date of Final Exam *
Please indicate the date you will be taking the final exam for this course
Your answer
Course Name (2)
Your answer
Course (2) Date
Please indicate the date you will be taking the final exam for this course
Your answer
Course Name (3)
Your answer
Course (3) Date
Please indicate the date you will be taking the final exam for this course
Your answer
You will be contacted by Orange Lutheran Online with test instructions prior to the test.
Please contact Cindy Schlichtemeier with any questions at cindy.schlichtemeier@lhsoc.org or 714-282-4679.
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