Wufoo

Designated Test Proctor Name * First Last
Name of Institution or Agency *
Phone Number * ### - ### - ####
Email *
AGREED AND ACCEPTED:
I have successfully completed the ACCUPLACER Certificate of Test Administration (ACTA) and agree to adhere to the guidelines established in the Test Security: Test Center Guidelines and Proctor Rules and Guidelines. *

Provide a print out of your ACTA certificate to Donna Felisberto. Scan and email to dfelisberto@necc.mass.edu or send to the Haverhill Campus, TC123.
Electronic Signature *
Date * MM / DD / YYYY
Do Not Fill This Out