To be signed
by student
AFFIDAVIT
OF Self-
study examinations must be proctored in a manner described below:
The
proctoring process must ensure that the examination will be completed by
the student on a closed-book basis and without assistance. The examination
may be proctored by a corporate training department, supervisor-appointed
co-worker or an approved test administration service; in any case, the
proctor will be required to submit an affidavit to the sponsor stating
that the specified conditions of administration were observed. Sponsors
are required to submit examination performance data with renewal applications.
Data should include the number of examinations administered, number passed,
number failed, number of retakes, percent passed, percent failed, etc.
PERSONAL RESPONSIBILITY
To be signed
by student
I
declare that I personally completed this exam without any outside assistance
including course material, other source material or assistance from any
person(s).
________________________________________________________
Signature (sign in ink only)Date
AFFIDAVIT OF EXAM COMPLETION
To be completed and signed by exam monitor
I
declare that I personally observed the above-named individual during the
completion of this examination and also observed that the producer received
no outside assistance in completing the examination.
_____________________________________________________________
Name
of StudentName of Course Exam
______________________________________________________________________________
Address
where exam was taken
_______________________________________________________
Date
exam was takenBeginning timeEnding
Time
Type
of monitor __Corporate Training
Dept.__ Supervisor___
Test administration service CEPP Instructor__
CEPP
Representative__Special
appointed __Co-worker __
____________________________________________________________
Print
name of person administering testJob
title of person administering test
____________________________________________________________
Company/agency
nameBusiness phone number
______________________________________________________________________________
Business mailing
address
___________________________________________________________
Signature
of person administering testDate
(Sign
in ink only)
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