Gpro Exam Proctor Application

URBAN GREEN COUNCIL

GPRO EXAM PROCTOR APPLICATION

Updated 7/5/11

Thank you for your interest in becoming a GPRO Certified Proctor. Please complete all fields below and return your application by email to with “Proctor Application/your name” in the subject line.

1) Name

First: Last:

2) Contact Information

Mailing Address Line 1:

Mailing Address Line 2:

City: State: Zip:

Telephone: Email:

3) Are you associated with a GPRO Delivery Partner?

Yes No Don’t Know

If Yes, which one(s)?

4) One of the following qualifications or related experience is required to be a GPRO Proctor. Please check all that apply:

Full-time, part-time or previous member of teaching faculty or an educational administrator of any accredited institution of higher education

Full-time, part-time or previous state-certified elementary or high school teacher, or school librarian

A public librarian who holds a library science degree

USGBC Chapter Staff Member

Other:

Please attach proof of experience when submitting this application. Briefly describe the attachment here:

5) Are you a citizen of the United States? Yes No

If No, are you allowed to legally work in the United States? Yes No

Please explain:

6) Are you presently employed? Yes No

If Yes, list your current employer:

Name:
Address:
City: State: Zip:
Occupation or Title:

Notes:

If No, what is your current status:

Retired Unemployed Other:

7) Highest level of education received:

High School College Postgraduate Other:

8) Have you proctored exams before? Yes No

If Yes, where?

Organization:
Address:
City: State: Zip:
Supervisor: Supervisor’s Phone or Email:

Notes:

9) List or attach two references (at least one must be professional):

Reference 1:

First Name: Last Name:
Title: Company:
Telephone: Email:

Notes:

Reference 2:

First Name: Last Name:
Title: Company:
Telephone: Email:
Notes:

10) Please list any professional certifications:

CERTIFICATION / TYPE / DATE RECEIVED / EXPIRATION

11) Language(s) spoken:

12) Test site availability (geographic location(s)):

13) Time available to proctor- check all that apply:

MORNING / AFTERNOON / EVENING
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY

14) Have you participated in any GPRO classes or are you a GPRO Certificate Holder?

Yes, please explain:

15) Have you ever been employed by, or do you have any current relationship with a company connected to the building industry?

Yes, please explain:

16) Have you ever been convicted of a crime?

Yes, please explain:

GPRO Proctor Application: Page 3/3