Please visit www.exemplarglobal.

org for your region’s Principal Office

contact details
Email: info@exemplarglobal.org

AUTHORIZED TEST CENTER/PROCTOR APPLICATION

PLEASE COMPLETE ALL SECTIONS OF THIS APPLICATION FORM.

PRIMARY CONTACT INFORMATION

The following individual will serve as the primary contact with Exemplar Global.

Name: Click here to enter text.

Business Name: Click here to enter text.
Mailing Address: Click here to enter text.
City: Click here to enter text.
State: Click here to enter text.
ZIP/Postal Code: Click here to enter text.
Country: Click here to enter text.

Main Telephone Number: Click here to enter text.

Secondary Telephone Number: Click here to enter text.
Fax Number: Click here to enter text.
Email Address: Click here to enter text.

INDIVIDUAL PROCTOR TESTING LOCATION:

(Please note: all proctoring of examinations must be conducted in a public venue, i.e., library, community center, etc.)
Name of Location: Click here to enter text.
Address: Click here to enter text.
City: Click here to enter text.
State: Click here to enter text.
ZIP/Postal Code: Click here to enter text.
Country: Click here to enter text.

This is a “controlled” document on day of printing only.

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 EXEMPLAR GLOBAL Commercial- In-Confidence when completed

EXAMINATIONS THAT WILL BE PROCTORED: (please choose all that apply)

Exemplar Global ☐ iNARTE ☐ FCC ☐

EXAMINATION DELIVERY: (please choose all that apply)

Computer-based: ☐ Paper-based: ☐

EXAMINATION FEES:
All test centers and proctors determine their own fees and collect those fees from the examinee.

The Exemplar Global (RABQSA), iNARTE, and FCC examinations are given in 4 hour or 8 hour blocks. Although
the examinee may not require this length of time to complete the examination, this time frame is guaranteed
to them.

The fee range for Exemplar Global, iNARTE, and FCC examinations is:
4 hour scheduled examination: $0.00 to a maximum of $75.00
8 hour scheduled examination: $0.00 to a maximum of $150.00

No fees other than the stated exam fee may be charged to the examinee, i.e., administration charges, etc.

Please enter your fees below:

Computer-Based 4 hours Examination: Click here to enter text.
Computer-Based 8 hours Examination: Click here to enter text.
(Examinations delivered via an online system; test centers or proctors would be required to supply internet access and
computer(s)/laptop(s) for delivery)

Paper-Based 4 hour Examination: Click here to enter text.

Paper-Based 8 hour Examination: Click here to enter text.
(Examinations are mailed to the test center or proctor, who administers then returns the exams to Exemplar Global)

IMPORTANT:
This is a “controlled” document on day of printing only.
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 EXEMPLAR GLOBAL Commercial- In-Confidence when completed

You may not require individuals to undertake any preparatory courses or purchase study materials in order to
examine at your location.

TRAINING:
Are any preparatory courses or training provided? Yes ☐ No ☐
If Yes, please provide course description(s) (attach additional pages if necessary)

Preparatory/training information contact: Click here to enter text.

Preparatory/training information phone: Click here to enter text.

TESTING SCHEDULE:
The opportunity to examine should be offered quarterly at minimum, and, under special provisions, on
request. If you are able to offer more frequent examinations, please indicate below:

☐ Quarterly ☐ By Appointment ☐ Other Click here to enter text.

HOURS OF OPERATION:
☐ Monday Choose an item. Choose an item.
☐ Tuesday Choose an item. Choose an item.
☐ Wednesday Choose an item. Choose an item.
☐ Thursday Choose an item. Choose an item.
☐ Friday Choose an item. Choose an item.
☐ Saturday Choose an item. Choose an item.
☐ Sunday Choose an item. Choose an item.

This is a “controlled” document on day of printing only.

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 EXEMPLAR GLOBAL Commercial- In-Confidence when completed

DO YOU HAVE ANY RESTRICTIONS AS TO THE EXAMINEES THAT YOU WILL PROVIDE PROCTORING
SERVICES FOR? (i.e., company employees only, military personnel only, etc.)
Click here to enter text.

TESTING LOCATION:
Please provide at least two photographs of the interior of the testing location showing testing area and
proctoring area)

A suitable testing location provides the examinee with a suitable work area that is quiet, comfortable and
properly illuminated. The testing location should also allow proper monitoring of the examinee(s), and
appropriate spacing between examinees.

Please identify how your site meets these requirements below:

(Attach additional pages if necessary)

Suitable Work Stations: Click here to enter a date.

Comfort & Illumination: Click here to enter text.

Quiet, Uninterrupted Room/Area: Click here to enter text.

Testing Location Capacity: Click here to enter text.

Monitoring: Click here to enter text.

Additional information: Click here to enter text.

Note: Once designated as an exam proctor, your testing location and/or exam session(s) may be inspected by
Exemplar Global without notice.

This is a “controlled” document on day of printing only.

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 EXEMPLAR GLOBAL Commercial- In-Confidence when completed

FOR MULTIPLE TEST CENTERS ONLY:

Testing Location(s)
Please provide at least two photographs of the interior of the testing location(s).

A suitable testing location provides the examinee with a suitable work area that is quiet, comfortable and properly illuminated. The testing location
should also allow proper monitoring of the examinee(s), and appropriate spacing between examinees.

In the table below, list all test center locations and complete the applicable information for each center. For the environment requirements, provide a
description of how the testing location supports each requirement (e.g., “individual work stations on 14 x 12 inch tables with divider between each”,
“video surveillance of examinees along with regular proctor walk-throughs”.) Attach additional pages if necessary.

Phone number and Type/

Name of Center Contact person at Frequency of
Address (if applicable) this location Proctor names examinations Environment requirements for this location
 Paper-based Work Stations:
Computer- Comfort &
based Illumination
Quiet, Uninterrupted
Room/Area:
Quarterly Testing Location
Appointment Capacity
Other Monitoring
Additional
information
 Paper-based Work Stations:
Computer- Comfort &
based Illumination
Quiet, Uninterrupted
Room/Area:
Quarterly Testing Location
Appointment Capacity
Other Monitoring
Additional
This is a “controlled” document on day of printing only.
Document Ref : Document1 Edition : 2 Issued 15-Jan-14 Printed : 12-Sep-19

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 EXEMPLAR GLOBAL Commercial- In-Confidence when completed

Phone number and Type/

Name of Center Contact person at Frequency of
Address (if applicable) this location Proctor names examinations Environment requirements for this location
information
 Paper-based Work Stations:
Computer- Comfort &
based Illumination
Quiet, Uninterrupted
Room/Area:
Quarterly Testing Location
Appointment Capacity
Other Monitoring
Additional
information
 Paper-based Work Stations:
Computer- Comfort &
based Illumination
Quiet, Uninterrupted
Room/Area:
Quarterly Testing Location
Appointment Capacity
Other Monitoring
Additional
information
 Paper-based Work Stations:
Computer- Comfort &
based Illumination
Quiet, Uninterrupted
Room/Area:
Quarterly Testing Location
Appointment Capacity
Other Monitoring
Additional
information

This is a “controlled” document on day of printing only.

Document Ref : Document1 Edition : 2 Issued 15-Jan-14 Printed : 12-Sep-19

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 EXEMPLAR GLOBAL Commercial- In-Confidence when completed

Application Package Checklist

This application form completed and signed.
At least two photographs of the testing location (must be the interior testing area).

I have read the Exemplar Global Proctor Manual (PCD66) and understand the requirements and
responsibilities of an Exemplar Global exam proctor. My signature below states that I am able to carry out the
duties and responsibilities of an Exemplar Global proctor.

___________________________________________________ ____________________
Signature of Requestor Date

Please email your application to:

Patty Roselle / Scheme and Exam Developer
proselle@exemplarglobal.org

This is a “controlled” document on day of printing only.

Document Ref : Document1 Edition : 2 Issued 15-Jan-14 Printed : 12-Sep-19

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