Proctor Application

First Name Title Company Address Last Name

Testing address if different from above Telephone URL Email LinkedIn

Proctor Qualification/Certification: Accredited by other organization (please provide documentation) Current ACORD Certified Expert Pursuing/plan to pursue ACORD Certified Expert Designation Certified proctor (please provide documentation) Human Resources or Training Department Staff/Management Other, please specify (please provide documentation as appropriate) Facility and Testing: Can your facility accommodate the physically disabled? Can we post your information on our website as a certified ACE proctor location? Will you accept non-employees who are taking ACE exams? Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes No No No No No No

I, the above named proctor applicant, hereby verify that all information on this application is true to the best of my knowledge. I will assume my role as proctor in a professional manner and adhere to all ACORD Proctor Guidelines when administering an examination. I understand that falsified information is grounds for disapproval. Signature Date

Submission & Questions

Submit your application to: ace@acord.org or +1 845 620 3638
Office use only Proctor Id #_____________________-

ACORD, Two Blue Hill Plaza, P.O box 1529, Pearl River, New York 10965 USA Phone +1 845 620 3600 Fax +1 845 620 3600 URL www.acord.org/ace
20130305