CTY Proctor Information Form

Please enter the information for the proctor who will administer the SCAT to your child. The proctor should be an educational professional such as an administrator, teacher, or counselor at your child's school. The proctor cannot be a family member or family friend .
Fields marked as (*) are required.

Proctor Information

First/Given Name*

Last Name/Surname*

Position at Your Child's School*

For example, counselor, teacher, or subject area or grade

Country*

Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Proctor's email*

Proctor's Telephone*

Include country and area code, if applicable.

Student Information

CTY Identification Number*

This is provided to you after enrolling in the CTY Talent Search.

Full Name*

Last Name/Surname, First Name/Given Name

Parent Signature

Parent/Guardian's Full Name*

Last Name/Surname, First Name/Given Name

Long Answer*

I confirm that the above named proctor is an educational professional who is neither a family member nor a friend of my child(ren) or me.

Date/Time

Parent/Guardian's Signature*

[clear]

Use your mouse or finger to draw your signature above.

By sharing information with the Johns Hopkins Center for Talented Youth (CTY) via this form, you agree to the privacy terms at: https://cty.jhu.edu/welcome/privstatement.html).