Agreement to Proctor Certification in Managed Care Nursing (CMCN) Examination
THIS FORM MUST BE COMPLETED AND RETURNED TO ABMCN BY THE PROCTOR
Guidelines for Proctor:
Proctor may be the candidate’s supervisor, a representative from the candidate’s human resources department of education/training department.
Proctor must agree to keep all materials and knowledge gained during the process, completely and totally confidential.
Proctor agrees to oversee the examination for a period of three hours and to assure that the candidate is in a secure environment (ie – away from computers, papers relevant to managed care, telephones, pagers, people, and other possible distractions).
Proctor agrees to not leave the candidate unsupervised during the examination.
Examinations are sent by Federal Express to the Proctor and are to arrive 3 days prior to the Test Date. Please plan accordingly.
Candidate Name:
Requested Examination Date:
Proctor Information:
Name:
Title:
Company:
Address:(specify if home or
business)
City, State, Zip:
Work Phone:
Fax Phone:
Email Address:
Proctor Signature:
Date:
If
above address is a home address, Federal Express will deliver without a
signature. Business addresses
must be complete with Suite, Mail Code,
Department, etc.
The CMCN Exam will NOT be sent without a completed proctor application.