A.A. Coleman & Robinson National Training Center
1-800-310-9622
Your complete test and this affidavit is to be faxed to:
1-410-734-7966
PERSONAL RESPONSIBILITY
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.
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
Resident of which state? ____________________________________________________
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 Student Name of Course Exam
Address where exam was taken
Date exam was taken: Beginning time Ending Time
Type of monitor _Corporate Training Dept. __Supervisor __Test administration service CEPP __Instructor __CEPP Representative____Special appointed __Co-worker
Print name of person administering test____________________________________________________
Company/agency name Business phone number________________________________________
Signature of person administering test Date
______________________________________________________
(Sign in ink only)
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