Distance Learning Facilitator’s Form
If you will be taking your course totally at a distance - that is without ever coming to campus to take exams - you must complete this form and forward it to your instructor for approval. Be sure to complete all sections and attach the appropriate identification. Fax it to the number provided by your instructor. Alternately, you may mail it to your instructor's attention at Southern Maine Community College, 2 Fort Road, South Portland, Maine 04106.
Remember: Your facilitator is the person who will be responsible for receiving, proctoring, and returning all your exams. Facilitators must be education officials at a university, community college or public school site, other governmental or community officials or, if such persons are unavailable, other persons approved in advance by the instructor. Relatives cannot be facilitators. You should submit the Facilitator's Form* prior at your earliest convenience but at least by the end of the first week of classes.
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*If the form does not open up, you should just print this page. Thank you for your patience as we get our new webpresence up and running well.
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Course Information |
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Course # and Title |
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Term |
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Student Information |
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Student's Name |
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SS# |
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Facilitator's Information |
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Name/Title |
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Affiliation |
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Address |
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Email |
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Phone/Fax |
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Facilitator’s Contract - Thank you for agreeing to facilitate testing for this student. You will receive tests by email in the form of an Adobe Acrobat .PDF file. You may return the completed exams by fax or by US mail, if you can do this within the stated time limits. The student is responsible for supplying postage and envelopes to you if you mail exams.
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Please be sure to: |
-Complete the Facilitator's Information above.
-Attach your business card or a photocopy of some form of identification.
-Read and sign the statement of responsibility below. |
Statement of Duties and Responsibilities - I will keep all test materials in a secure location when not in use. I will not make duplicate copies of tests without permission of the instructor. I will not give the student access to the test before it is administered. I will check identification to be certain the correct person is taking these tests. I will return completed test materials as soon as possible. I will return or destroy all unused test materials.
I have read the description of my duties as facilitator. I understand that I am responsible for preserving the integrity of the test materials for this course and the testing process for the above named student.