Orange Lutheran Online Proctor Certification Form
Student LAST Name *
Student FIRST Name *
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
Proctor Position/Job Title *
Proctor Phone Number *
(include area code)
Proctor's School or Organization Name *
Street Address
City
State
Zip
Proctor Email *
The Proctor is: *
If the proctor is related to the student what is the relationship
Course Name (1) *
Course (1) Date of Final Exam *
Please indicate the date you will be taking the final exam for this course
Course Name (2)
Course (2) Date
Please indicate the date you will be taking the final exam for this course
Course Name (3)
Course (3) Date
Please indicate the date you will be taking the final exam for this course
Your proctor will be contacted by Orange Lutheran Online with test instructions one day prior to the test.
Please contact Cindy Schlichtemeier with any questions at cindy.schlichtemeier@lhsoc.org or 714-282-4679.
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