Managing External Relations - Disaster Management Center ...
Managing External Relations - Disaster Management Center ...
Managing External Relations - Disaster Management Center ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
<strong>Disaster</strong> <strong>Management</strong> <strong>Center</strong><br />
University of Wisconsin-Madison<br />
Examination Request Form<br />
This exam must be proctored (supervised) just as it would be for a course taken on campus. Generally, proctors do<br />
not charge for this service. In all cases the academic department offering the course must approve the choice of<br />
proctor. Qualified proctors include university or college registrars, deans or counselors or professors; high school<br />
principals or counselors; directors of educational services at universities, other educational organizations,<br />
correctional institutions or the armed services; certified librarians in a supervisory position; or the delegated officials<br />
at university testing centers. Students residing outside of the United States may also request, as their proctor, a<br />
local director of educational services or an officer of the United States embassy or consulate. Please copy this<br />
form as needed.<br />
Date Submitted ________________________________________________________________<br />
Course Title ________________________________________________________________<br />
Student Information:<br />
Name ________________________________________________________________<br />
Mailing Address ________________________________________________________________<br />
Proctor Information:<br />
________________________________________________________________<br />
________________________________________________________________<br />
Name ________________________________________________________________<br />
Title ________________________________________________________________<br />
Organization ________________________________________________________________<br />
Complete Mailing Address (Please provide street address, in case courier service is used.)<br />
________________________________________________________________<br />
________________________________________________________________<br />
________________________________________________________________<br />
Phone Number OR<br />
Email Address ________________________________________________________________<br />
Please return this form by mail or fax, or send the information via e-mail to:<br />
University of Wisconsin–<strong>Disaster</strong> <strong>Management</strong> <strong>Center</strong><br />
432 Lake Street<br />
Madison, Wisconsin 53706, USA<br />
Fax: 1-608-263-3160 E-mail: dmc@engr.wisc.edu