CITC - Canadian Institute of Travel Counsellors - CTC, CTM & BC Travel Insurance

Proctor Application Form

Fields marked with are required

Please note that this form is to be completed personally by the proctor ONLY.
If this form is completed by the exam candidate or anyone else,
then the application will automatically be rejected.

Please do not complete this application form before you have read the full 20 page Proctor Guide which is available here. If you are submitting this online application form,
please DO NOT submit the faxed application form in the Proctor Guide.
For information on how CITC protects your personal information, please see our privacy policy.

Proctor Info (Please complete all fields)

Name (first and last)

Position

Company

Address

City

Province

Postal Code

Country

Business Email

Please note that some email services may send emails from CITC into your junk/spam folder. Therefore, always check.

Telephone

Include area code: xxx-xxx-xxxx

Cell Phone

Proctoring Type (Individual or Group?)

How many people are you proctoring?

	1-4 (Complete blue section below)
	5 or more (Complete green section below)

Individual Exams (If you are proctoring for 1 to 4 individuals, please complete this section)

Candidate Name(s)
Please list the name(s) of the candidate(s) for whom you are proctoring

Exam Info
Please indicate the date, location and time of the exam.

Exam Date   mm/dd/yyyy

Exam Time    eg. 1:00pm

Exam Location   eg. 505 Consumers Rd

Related to Candidate?
Are you related to any of the candidates writing the exam? If yes, and if you’re proctoring for more than one candidate, please name the candidate(s) to whom you are related.

Yes No
If Yes, name candidate

Friend of Candidate?
Would you consider any of the candidates as a friend? If yes and if you’re proctoring for more than one candidate, please name the candidate with whom you are friends.

Yes No
If Yes, name candidate

Is the above named person a friend or an acquaintance? Please explain.

Worked with Candidate?
Have you ever worked with any of the candidate(s) before? If yes, please indicate the candidate’s name(s) and how long ago (in years).

Yes No
If Yes, name candidate eg. Kathy, Joe
If Yes, number of years
eg. 10, 5

Intend to Work with Candidate?
Do you intend to work with the candidate(s) in the future? If yes, and if you’re proctoring for more than one candidate, please indicate the candidate’s name.

Yes No
If Yes, name candidate

Afilliated with Candiate's Agency?
Is your agency/workplace in any way affiliated with the candidate’s agency? If yes, please explain in what way your business is linked to the candidate’s agency.

Yes No
If Yes, please explain how linked

Group Exams (If you are proctoring for 5 or more candidates, please complete this section)

Group/Agency Name
Please enter group/agency name for whom you’re proctoring (if applicable)

Example: Joe's Travel

Exam Info
Please indicate the date, time and location of the exam.

Exam Date   mm/dd/yyyy

Exam Time    eg. 1:00pm

Exam Location   eg. 505 Consumers Rd

Related to Candidate(s)?
Are you related to any of the candidates writing the exam? If yes, please name the candidate to whom you are related.

Yes No
If Yes, name candidate

Friend of Candidate(s)?
Would you consider any of the candidates as friends? If yes, please name the candidate(s) with whom you are friends.

Yes No
If Yes, name candidate

Is the above named person a friend or an acquaintance? Please explain.

Worked with Candidate(s)?
Have you ever worked with any of the candidates before? If yes, please indicate the candidate(s)’s name(s) and how long ago (in years).

Yes No
If Yes, name candidate(s) eg. Kathy, Joe
If Yes, number of years
eg. 10, 5

Intend to Work with Candidate(s)?
Do you intend to work with the candidate(s) in the future? If yes, and if you’re proctoring for more than one candidate, please indicate the candidate’s name.

Yes No
If Yes, name candidate

Yes No
If Yes, please explain how linked

Experience with the Travel Industry
(Please complete all fields)

Have you already written the exam? If yes, please enter your result as well as your exam date.

Yes   No
If Yes, enter exam result (Pass / Fail)

Exam Date   mm/dd/yyyy

Is it your intention to write the TICO exam at some point?

Yes No

Understanding of the Proctor Guide
(Please complete all fields)

Have you read the entire Proctor Guide?

Yes No

Do you understand the responsibilities of a Proctor as outlined in the Proctor Check List (Appendix G of the Proctor Guide)?

Yes No

Do you have any questions about your responsibilities? If yes, CITC will contact you.

Yes No

Declaration: I (type name of Proctor) qualify to be a Proctor based on the criteria listed in the Proctor Guide. I declare that I have no conflict of interest with any of the candidates writing the exam and that I am not related to any of them. I affirm that I will not divulge any information on the exams or copy, reproduce or store in an electronic system or any other storage system, any of the information contained in, or information about, the exam. I further affirm that I have read and I understand my responsibilities, as described in the Proctor Guide.

Terms & Conditions Agreement

By typing my name and submitting this form, I am attesting to the truthfulness of all of my responses

CITC Proctor Referral?

Check box if you would like CITC to suggest your name as a Proctor to other candidates.

Comments

Please note that TICO performs random spot checks at exam writing venues and may, with proper ID, attend the session you are proctoring.

Thank you for your application! Please fax or email a copy of your business card or government issued ID within 24 hours of submitting this form to the following:

Attn: Ms. Kulsum Murtaza
Fax: 416-484-4140
Email: ticotest@citc.ca


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